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Sample records for anal condyloma acuminatum

  1. Anal condyloma acuminatum.

    PubMed

    McCutcheon, Tonna

    2009-01-01

    Anal condyloma acuminatum is a human papillomavirus (HPV) that affects the mucosa and skin of the anorectum and genitalia. Anal condyloma acuminatum is the most commonly diagnosed sexually transmitted disease in the United States. To date, there are more than 100 HPV types, with HPV-6, HPV-10, and HPV-11 predominately found in the anogenital region and causing approximately 90% of genital warts. Risk factors for anal condyloma acuminatum include multiple sex partners, early coital age, anal intercourse, and immunosuppression. Transmission occurs by way of skin-to-skin contact through sexual intercourse, oral sex, anal sex, or other contact involving the genital area. The virus may remain latent for months to years until specific mechanisms cause production of viral DNA, leading to the presentation of anal condyloma acuminatum.Patients with anal condyloma acuminatum may be asymptomatic or present with presence of painless bumps, itching, and discharge or bleeding. It is not uncommon to have involvement of more than one area, and multiple lesions may also be present and extend into the anal canal or rectum. To date, there is no serologic testing or culture to detect anal condyloma acuminatum; therefore, diagnosis is made clinically or by detection of HPV DNA. Multiple factors determine the choice of treatment, which may range from patient-applied medications to surgical intervention. Despite treatment choice, recurrence rates are high, indicating the importance of patient education on prevention of HPV infection and reinfection. Unfortunately, at this time, no cure exists for anal condyloma acuminatum; however, recently Gardasil and Cervarix (in Australia only) vaccines have become available and are showing promising results. PMID:19820442

  2. Total excision and V-Y plasty technique in the anal area condyloma acuminatum.

    PubMed

    Demirel, Arif H; Ongoren, Ali U; Bingül, Ferruh; Gulcelik, Nevzat

    2008-01-01

    Condyloma acuminatum is located in the perianal region, anal canal, vagina and the perineum. It is caused by human papillomavirus types 6 and 11. A 18 year-old man was admitted to the clinic because of a perianal mass. On examination of the patient's perianal area and inside the anal canal, a mass was found, which was nearly 8 x 8 cm in size. We could not obtain any information about venereal transmission. The mass was totally excised and the defect was reconstructed with a bilateral V-Y advancement flap. This technique has been used for sacrococcygeal, ischial and other defects but rarely used for condyloma acuminatum. We think that total excision and the use of the V-Y advancement flap technique is safe and has low morbidity in the treatment of condyloma acuminatum. PMID:19753205

  3. Condyloma acuminatum of the anal canal, treated with endoscopic submucosal dissection

    PubMed Central

    Sasaki, Akiko; Nakajima, Takeshi; Egashira, Hideto; Takeda, Kotaro; Tokoro, Shinnosuke; Ichita, Chikamasa; Masuda, Sakue; Uojima, Haruki; Koizumi, Kazuya; Kinbara, Takeshi; Sakamoto, Taku; Saito, Yutaka; Kako, Makoto

    2016-01-01

    Condyloma acuminatum (CA) is a common sexually transmitted disease caused by human papilloma virus infection. Not all individuals develop persistent, progressive disease, but careful follow up is required with moderate-to-severe dysplasia to prevent progression to malignancy. Standard therapies include surgical treatments (trans-anal resection and trans-anal endoscopic microsurgery) and immunotherapeutic and topical methods (topical imiquimod); however, local recurrence remains a considerable problem. Here, we report a case with superficial CA of the anal canal, treated with endoscopic submucosal dissection (ESD). A 28-year-old man presented with a chief complaint of hematochezia. Digital exam did not detect a tumor. Screening colonoscopy revealed 10-mm long, whitish condyles extending from the anal canal to the lower rectum. The lesion covered almost the whole circumference, and only a small amount of normal mucosa remained. Magnifying endoscopy with narrow band imaging showed brownish hairpin-shaped, coiled capillaries. Although histopathological diagnosis by biopsy revealed CA, accurate histological differentiation between CA, papilloma, and squamous cell carcinoma can be difficult with a small specimen. Therefore, we performed diagnostic ESD, which provides a complete specimen for precise histopathological evaluation. The pathological diagnosis was CA, with moderate dysplasia (anal intraepithelial neoplasia 2). There was no recurrence at 16 mo after the initial ESD. Compared to surgical treatment, endoscopic diagnosis and resection could be performed simultaneously and the tumor margin observed clearly with a magnifying chromocolonoscopy, resulting in less recurrence. These findings suggest that endoscopic resection may be an alternative method for CA that prevents recurrence. PMID:26937152

  4. Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum

    PubMed Central

    Agnew, Jennifer L.; Strombom, Paul D.; Fong, Carmen F.; Kelly, Timothy J.; Martz, Joseph E.

    2015-01-01

    Introduction Pyoderma gangrenosum (PG) is a rare, inflammatory skin pathology frequently associated with systemic inflammatory disease. While rare after surgery, recognition of this disease in the post-surgical setting is important as it can mimic wound infection. Presentation of case We herein present a dramatic presentation of perianal PG four days after routine excision and fulguration of anal condyloma acuminatum. The affected area did not improve with broad spectrum antibiotics or surgical debridement. A diagnosis of PG was made from clinical suspicion and pathology findings, and further confirmed with rapid improvement after starting steroids. Diagnosis of this disease in the postoperative period requires high suspicion when the characteristic ulcerative or bullae lesions are seen diffusely and show minimal improvement with antibiotic treatment or debridement. Discussion Our case highlights the importance of recognizing this disease in the post-operative period, to allow for early initiation of appropriate treatment and prevent unnecessary surgical debridement of a highly sensitive area. There have been 32 case reports of PG in the colorectal literature, mostly following stoma creation. There is one case report of idiopathic perianal pyoderma gangrenosum with no known prior trauma. To our knowledge there are no previously reported cases of perianal PG after routine elective anorectal surgery. Conclusion This is the first reported case of perianal pyoderma gangrenosum in the post-surgical setting. Increased awareness of pyoderma gangrenosum in the surgical literature will aid in prompt diagnosis and proper medical management of this uncommon postoperative morbidity. PMID:26547888

  5. Condyloma acuminatum of the buccal mucosa.

    PubMed

    Jaiswal, Rashmi; Pandey, Manoj; Shukla, Mridula; Kumar, Mohan

    2014-06-01

    Condyloma acuminatum is a human papillomavirus (HPV)-induced disease. It is usually transmitted sexually, and it frequently occurs in the anogenital area. A finding of condyloma acuminatum in the oral cavity is rare. Besides HPV, other risk factors for oral condyloma include chewing betel quid and smoking. We report the case of a 52-year-old man who presented with a 2 × 2-cm verrucous white patch on his buccal mucosa. He was habituated to both betel quid and cigarette smoking. A biopsy of the lesion identified it as a verrucous hyperplasia of the squamous epithelium with HPV-related koilocytic changes. The lesion was excised, and further histopathology identified it as condyloma acuminatum. The patient was disease-free 9 months postoperatively. The possibility of condyloma acuminatum should be considered in the differential diagnosis of an oral white lesion. The most common treatments are surgical excision, cryosurgery, electrocautery, and laser excision. There is no known role for antiviral therapy. PMID:24932820

  6. Perianal giant condyloma acuminatum (Buschke-Löwenstein tumor).

    PubMed

    Shenoy, Santosh

    2014-01-01

    A 50-year-old heterosexual, HIV-negative man presented with a giant anal condyloma (Figure). He had iron deficiency anemia, a slow-growing anal wart for many years, and intermittent bleeding and pruritus. Esophagogastroduodenoscopy and colonoscopy findings were normal. Endoscopic ultrasound of the anorectum showed no anal sphincter involvement, and computed tomography did not reveal any pelvic inguinal lymph nodes. Wide-staged excision was performed and the patient recovered well with resolution of symptoms and no local recurrence at 1-year follow-up. Final pathology confirmed human papillomavirus (HPV) 6 strain and a giant condyloma acuminatum with mild atypia and no malignancy. Further examination of his oropharynx showed additional small HPV lesions, which were removed locally. PMID:24933853

  7. Giant Condyloma Acuminatum of Vulva Frustrating Treatment Challenge

    PubMed Central

    Niazy, Feizollah; Rostami, Khalil; Motabar, Amir Reza

    2015-01-01

    Giant condylomata are not usually seen nowadays in developed nations, but such cases are still seen in the under-resourced countries. Condylomata acuminata are commonly transmitted through sexual intercourse. Generally diagnosed based on their appearance. Giant condyloma acuminata also named Buschke- Löwenstein tumour (BLT) is a slow growing cauliflower-like tumor, locally aggressive and destructive, with possible malignant transformation. Common clinical treatment of anogenital warts is conservative, however, in extreme cases conservative therapy is insufficient and surgical excision is required. A case of common presentation of giant condylomata in a 50 years old, divorced, multiparous woman is presented and the literature is reviewed. She presented with 15 years history of slowly progressive vulval lesion and associated itching, contact bleeding, malodorous vaginal discharge and difficulty in walking. She had previously been treated with podophyllin and cryosurgery without success. The growth measured 30×10 cm in each side and was successfully excised with no evidence of malignancy concomitant and reconstruction also done. PMID:26284185

  8. Anorectal giant condyloma acuminatum (Buschke-Loewenstein tumor): CT and radiographic manifestations

    SciTech Connect

    Balthazar, E.J.; Streiter, M.; Megibow, A.J.

    1984-03-01

    Giant condyloma acuminatum (Buschke-Loewenstein tumor) is an unusual variety of venereal wart characterized by a large size, cauliflower-like appearance, and locally invasive nature. CT examination of two patients with anorectal giant condylomata revealed the papillomatous and invasive nature of the lesion and the extent of tumor; there was infiltration of the subcutaneous tissue, perirectal fascial planes, and luminal narrowing with marked thickening of the rectal wall. The pathologic specimens showed benign histologic finding in one case and a mixed pattern with areas of malignant degeneration in the other. CT accurately demonstrated the exact location and extent of the lesions. The presence of malignant degeneration in this inherently invasive lesion can be established only on histologic examination.

  9. Successful Surgical Management of Giant Condyloma Acuminatum (Buschke Lowenstein Tumor) in the Urethra of a Female Patient: A Case Report

    PubMed Central

    Nordsiek, Michael; Ross, Curtis; Metro, Michael

    2015-01-01

    The Buschke-Lowenstein tumor (BLT) is a slow-growing, locally destructive verrucous plaque that typically appears on the penis but may occur elsewhere in the anogenital region. It most commonly is considered to be a regional variant of verrucous carcinoma. It is rare but accounts for 5-24% of all penile cancers. It can also affect the perineum and other portions of the genitalia. It was first described by Buschke and Löwenstein in 1925, and is also known as giant condyloma acuminatum (GCA). Regardless of the treatment modality, careful follow-up is recommended because of the high risk of recurrence and the possibility for malignant transformation in 30-56% of patients. We present a case of a 47-year-old Hispanic female that presented to the urology clinic for dysuria and upon work-up was found to have a GCA. GCA typically affects the penis, although the perianal region, vulva, vagina, rectum, scrotum, perineum and bladder may be involved. To date, we believe this is the only reported case of GCA in the urethra of a female patient with sparing of the bladder. This lesion was successfully removed with wide local excision. We believe that further studies are needed to define this disease, identify its pathogenesis, and the most successful treatment protocol. PMID:26195964

  10. Prevention of Anal Condyloma with Quadrivalent Human Papillomavirus Vaccination of Older Men Who Have Sex with Men

    PubMed Central

    Swedish, Kristin A.; Goldstone, Stephen E.

    2014-01-01

    Background The quadrivalent human papillomavirus vaccine (qHPV) is FDA-approved for use in males 9 to 26 years old to prevent anogenital condyloma. The objective of this study is to determine if qHPV is effective at preventing anal condyloma among men who have sex with men (MSM) aged 26 years and older. Methods This post-hoc analysis of a nonconcurrent cohort study evaluated 210 patients without history of anal condyloma and 103 patients with previously-treated anal condyloma recurrence-free for at least 12 months prior to vaccination/time zero. We determined the rate of anal condyloma development in vaccinated versus unvaccinated patients. Results 313 patients with mean age 42 years were followed for median 981 days. During 773.6 person-years follow-up, condyloma developed in 10 (8.6%) vaccinated patients (incidence of 3.7 per 100 person-years) and 37 (18.8%) unvaccinated patients (incidence 7.3 per 100 person-years; p = 0.05). Multivariable hazards ratio showed that qHPV was associated with decreased risk of anal condyloma development (HR 0.45; 95% CI 0.22–0.92; p = 0.03). History of anal condyloma was associated with increased risk of anal condyloma development (HR 2.28; 95% CI 1.28–4.05; p = 0.005), as was infection with oncogenic HPV (HR 3.87; 95% CI 1.66–9.03; p = 0.002). Conclusions Among MSM 26 years of age and older with and without history of anal condyloma, qHPV reduces the risk of anal condyloma development. A randomized controlled trial is needed to confirm these findings in this age group. PMID:24714693

  11. Giant Condyloma Acuminatum in the Genital, Perineal and Perianal Region in a Pediatric Patient. Literature Review and Case Report.

    PubMed

    Suárez-Ibarrola, Rodrigo; Heinze, Alexander; Sánchez-Sagástegui, Fabian; Negrin-Ramírez, Atziri; Aguilar-Anzures, Roberto; Xochihua-Diaz, Luis; Cuevas-Alpuche, Juan Osvaldo

    2016-07-01

    Condyloma acuminata is caused by the proliferation of squamous epithelial cells in the presence of human papilloma virus (HPV) infection. There are several treatment options available for anogenital warts, however, none have proven to be more efficacious. We present the case of a 3 year-8 months-old male, diagnosed with human immunodeficiency virus (HIV) infection, who presented with multiple warts in the anogenital region. Lesions were treated with imiquimod 5%, electrosurgical resection and interferon α-2b. Combination of electrofulguration and interferon α-2b is an effective treatment option for children with giant condyloma accuminatum although recurrence is expected within a short follow-up period. PMID:27335781

  12. Giant Condyloma Acuminata of the Inguinal Region.

    PubMed

    Nain, Prabhdeep Singh; Sidhu, Sudeep; Garg, Bhavna

    2015-12-01

    A 70-year-old male presented with a progressively increasing polypoidal lesion in the right inguinal region since last 10 years. He had no anal or penile lesion. Excision biopsy was done under spinal anaesthesia. Histopathology showed it to be a giant condyloma acuminata. We report this case due to its large size and its location in inguinal region without pre-existing anal or rectal lesion. PMID:26730100

  13. A surgical approach to giant condyloma (Buschke-Löwenstein tumour) with underlying superficial vulvar carcinoma: A case report

    PubMed Central

    ZEKAN, JOSKO; PETROVIC, DAVOR; EL-SAFADI, SAMER; BANOVIC, MAJA; HULINA, DAVOR; HRGOVIC, ZLATKO

    2013-01-01

    Anogenital warts (condyloma acuminatum or venereal warts) are a common sexually transmitted disease in males and females. Common clinical treatment of anogenital warts is conservative, however, in extreme cases conservative therapy is insufficient and surgical excision is required. Giant condyloma acuminata (Buschke-Löwenstein tumour) is an extremely rare clinical type of genital wart, characterised by aggressive down growth into underlying dermal structures. A 55-year-old female presented with cauliflower-like growth over the anogenital and sacral region, earlier diagnosed as condyloma acuminatum which was resistant to conservative therapy. During the period between 2005 and 2008 the patient underwent five surgical procedures. Due to the size and location of the tumour, gynaecological and plastic surgeons were involved in the procedures. In addition, definitive histology examination identified a superficial vulvar carcinoma. PMID:23420321

  14. Condyloma with lichen nitidus.

    PubMed

    Scheinfeld, Noah S; Lehman, Daniel

    2005-01-01

    A 32-year-old black man presented with two separate eruptions on his penis (Figure). He has had a 10-year history of asymptomatic 1-3 mm shiny papules on the shaft of his penis. He also has had one asymptomatic verrucous brown plaque 1.5 cm in diameter on his penis. A small shave biopsy was performed for each process. The former showed lymphocytes and histocytes in the papillary dermis in a "ball-in-claw" relation to the rete ridges of the epidermis. The latter showed an acanthotic epidermis with papillomatosis. Diagnoses of lichen nitidus and condyloma acuminata were respectively made. As the shiny papules did not bother the patient, but he wanted to be rid of the verrucous plaque, only the latter was treated. Liquid nitrogen was applied to the plaque. The patient was also given podofilox 0.5% gel to apply to the condyloma overnight on Monday, Tuesday, and Wednesday, with a 4-day respite. This cycle was to be repeated for 3 more weeks. He was examined several more times and treated with cryotherapy and podofilox gel with the near disappearance of the condyloma over 4 months. PMID:15891255

  15. Colposcopy in the diagnosis of penile condyloma.

    PubMed

    Sedlacek, T V; Cunnane, M; Carpiniello, V

    1986-03-01

    To determine the incidence of penile condyloma in a group of high-risk men, we carried out colposcopy and biopsy of suspicious lesions in 51 men. All men were partners of women with condyloma. Of these men, 45 were found to have histologic evidence of condyloma, and only eight of these had grossly visible disease. PMID:3953697

  16. Collection and seed production of Allium acuminatum

    Technology Transfer Automated Retrieval System (TEKTRAN)

    As a component of Greater Sage-Grouse and Southern Idaho Ground Squirrel habitat, Allium acuminatum Hook. (Taper-tip onion) has been targeted for use in restoration projects and conservation. Before a native plant can be used in large or small projects in the landscape quantities of propagules nee...

  17. Condyloma acuminata in child end laser therapy: a case report

    PubMed Central

    2009-01-01

    Background Condyloma acuminata are soft, skin colored, fleshy warts that are caused by the Human Papilloma Virus (HPV). The disease is highly contagious, can appear singly or in groups, small or large. The incubation period may be from 1–6 months. Although anogenital warts are considered to be sexually transmitted in adults, this may not be the case for children. Genital warts in children may result from several modes of transmission: from the maternal genital tract autoinoculation, from finger warts and nonsexual transmission from members/careers. Case presentation The presented case is a 13-month-old girl. She was hospitalized at the Clinic of Dermatovenerology in 2001 due to papillomatosis changes on the genital area. The changes had started to appear in the sixth month of life, light purple in color, smooth and combined in a tumorous mass, in the vulva and anal areas. Conclusion From this case we can come to the conclusion that condyloma acuminate are not only transmitted sexually but through nonsexual ways as well, such is this case, from the infected mother to the infant. Laser therapy is preferred when multiple warts are spread over a large area as though in our case. PMID:19193210

  18. Allium acuminatum Seed Production: First Look at Cultural Parameters

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This is a report on the first year data for a two year project assessing seed production parameters for the native forb Allium acuminatum. As a component of greater sage-grouse and Southern Idaho ground squirrel habitat, Allium acuminatum Hook. (Taper-tip onion) has been targeted for use in restor...

  19. Anal Warts and Anal Intradermal Neoplasia

    PubMed Central

    Echenique, Ignacio; Phillips, Benjamin R.

    2011-01-01

    For the last five millennia we have been dealing with the annoyance of verrucas. Anogenital human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States and is increasing in incidence. As in other gastrointestinal conditions, HPV infection can lead to a stepwise transition from normal cells to dysplastic cells and then to invasive anal cancer. Knowledge of the natural history of HPV infection, risk factors, diagnostic tools, and therapeutic methods gives us the tools to adequately prevent, evaluate, treat, and counsel our patients. In this review, the authors detail the diagnosis, management, and treatment of anal condyloma and anal intraepithelial neoplasia with a focus on prevention, early detection, and treatment using current data and technology. PMID:22379403

  20. Identification of Ina proteins from Fusarium acuminatum

    NASA Astrophysics Data System (ADS)

    Scheel, Jan Frederik; Kunert, Anna Theresa; Pöschl, Ulrich; Fröhlich-Nowoisky, Janine

    2015-04-01

    Freezing of water above -36° C is based on ice nucleation activity (INA) mediated by ice nucleators (IN) which can be of various origins. Beside mineral IN, biological particles are a potentially important source of atmospheric IN. The best-known biological IN are common plant-associated bacteria. The IN activity of these bacteria is induced by a surface protein on the outer cell membrane, which is fully characterized. In contrast, much less is known about the nature of fungal IN. The fungal genus Fusarium is widely spread throughout the earth. It belongs to the Ascomycota and is one of the most severe fungal pathogens. It can affect a variety of organisms from plants to animals including humans. INA of Fusarium was already described about 30 years ago and INA of Fusarium as well as other fungal genera is assumed to be mediated by proteins or at least to contain a proteinaceous compound. Although many efforts were made the precise INA machinery of Fusarium and other fungal species including the proteins and their corresponding genes remain unidentified. In this study preparations from living fungal samples of F. acuminatum were fractionated by liquid chromatography and IN active fractions were identified by freezing assays. SDS-page and de novo sequencing by mass spectrometry were used to identify the primary structure of the protein. Preliminary results show that the INA protein of F. acuminatum is contained in the early size exclusion chromatography fractions indicating a high molecular size. Moreover we could identify a single protein band from IN active fractions at 130-145 kDa corresponding to sizes of IN proteins from bacterial species. To our knowledge this is for the first time an isolation of a single protein from in vivo samples, which can be assigned as IN active from Fusarium.

  1. The 18F-FDG PET/CT finding of a condyloma acuminata mimicking primary anorectal carcinoma in an HIV-infected patient.

    PubMed

    Kim, Bom Sahn

    2013-10-01

    This case report describes a condyloma acuminata with intense FDG uptake mimicking primary anorectal carcinoma in an HIV-infected patient.A 44-year-old HIV-positive homosexual man with a history of lymphoma underwent an 18F-FDG PET/CT for restaging. A focal intense hypermetabolic lesion around the anorectal area was found by the PET/CT and it was suggested as a tumorous lesion. However, the lesion was not detected on the contrast-enhanced abdominal CT. Via a sigmoidoscopy, cauliflower-like masses were visualized in the intra-anal area. The tumor was surgically excised and proven to be condyloma acuminata by permanent pathology. PMID:22996249

  2. Anal Cancer

    MedlinePlus

    ... saved articles window. My Saved Articles » My ACS » Anal Cancer Download Printable Version [PDF] » Whether you (or ... the topics below to get started. What Is Anal Cancer? What is anal cancer? What are the ...

  3. Anal Cancer

    MedlinePlus

    ... are here Home > Types of Cancer > Anal Cancer Anal Cancer This is Cancer.Net’s Guide to Anal Cancer. Use the menu below to choose the ... social workers, and patient advocates. Cancer.Net Guide Anal Cancer Introduction Statistics Risk Factors and Prevention Screening ...

  4. [Anal suppurations].

    PubMed

    Senéjoux, A

    2001-01-15

    Anal suppurations can be classified according to their origin: from the anal canal, from above the anal canal, or independent from the ano-rectum. Wherever suppuration comes from, an abscess can be present at the acute phase. Anal fistulas represent about 70% of anal suppurations. They always begin by cryptoglandular infection, which can spread to the intersphincteric space and then pass through the anal sphincter. Treatment of anal fistula is a double challenge: healing the suppuration, and preserving anal continence. Among suppurations independent from the ano-rectum pilonidal disease is the most frequent (15% of the suppurations). Other causes of ano-perineal suppurations are infected fissure, Verneuil's disease, and gland, recto-vaginal fistulas and Crohn's disease. PMID:11234090

  5. Anal cancer

    MedlinePlus

    ... Sexual activity. Having many sexual partners and having anal sex are both major risks. This may be due ... have sex with many partners or have unprotected anal sex are at high risk of these infections. Using ...

  6. The Giant Condyloma (Buschke-Löwenstein Tumor) in the Immunocompromised Patient

    PubMed Central

    Atkinson, Andrew L.; Sisay, Abinet

    2014-01-01

    Since Buschke and Löwenstein first described the giant condyloma in 1925 (which subsequently was named Buschke-Löwenstein tumor), there have been scattered reports over the past 90 years describing presentation and different avenues of treatment for patients with this condition. It is well known that immunocompromised individuals are at an increased risk of anogenital disease caused by human papillomavirus (HPV). In this report, we present the management of two HIV positive patients with giant condylomas. Both patients presented with urinary outflow obstruction and sepsis. Though giant condylomas are a rare phenomenon, these two cases underscore the importance of early treatment intervention, especially in the immunocompromised patient. PMID:25328732

  7. The giant condyloma (buschke-löwenstein tumor) in the immunocompromised patient.

    PubMed

    Atkinson, Andrew L; Pursell, Nicole; Sisay, Abinet

    2014-01-01

    Since Buschke and Löwenstein first described the giant condyloma in 1925 (which subsequently was named Buschke-Löwenstein tumor), there have been scattered reports over the past 90 years describing presentation and different avenues of treatment for patients with this condition. It is well known that immunocompromised individuals are at an increased risk of anogenital disease caused by human papillomavirus (HPV). In this report, we present the management of two HIV positive patients with giant condylomas. Both patients presented with urinary outflow obstruction and sepsis. Though giant condylomas are a rare phenomenon, these two cases underscore the importance of early treatment intervention, especially in the immunocompromised patient. PMID:25328732

  8. [Japanese HIV-infected men who have sex with men screened for anal intraepithelial neoplasia].

    PubMed

    Itoda, Ichiro; Kitamura, Hiroshi

    2011-11-01

    The prevalence of and the risk factors for abnormal anal cytology among Japanese men who have sex with men (MSM) who have human immunodeficiency virus (HIV) infection have not been fully investigated up to now. We conducted a nested case-control study of 81 HIV-infected Japanese MSM treated with antiretroviral therapy at a sexuality minority affirmative clinic between April 2010 and March 2011. Results showed that 41 (50.6%) of the 81 had normal anal cytology, 13 (16.0%) atypical squamous cells, 24 (29.6%) low-grade squamous intraepithelial lesions, and 3 (3.7%) high-grade squamous intraepithelial lesions. No carcinoma cases were seen. Multivariate analysis showed abnormal anal cytology to be associated with a history of genital condyloma (OR 4.19, p = .021). We concluded that abnormal anal cytology was common among HIV-infected Japanese MSM. Effective screening and management should be planned for precancerous anal lesions. PMID:22250457

  9. Anal cancer

    MedlinePlus

    ... the last part of your large intestine where solid waste from food (stool) is stored. Stool leaves your body through the anus when you have a bowel movement. Anal cancer is fairly rare. It spreads ... Squamous cell carcinoma. This is the most common type of anal cancer. It starts in cells that ...

  10. Anal fissure.

    PubMed

    Metcalf, Amanda M

    2002-12-01

    Anal fissure is a common condition with a characteristic presentation. Despite increased pharmaceutical options in the medical management of anal fissures, surgical therapy is not in danger of becoming obsolete. Lateral internal sphincterotomy remains an attractive option for many patients suffering from this painful condition. PMID:12516855

  11. Anal fissure

    MedlinePlus

    ... pain interferes with normal bowel movements Petroleum jelly Zinc oxide, 1% hydrocortisone cream, Preparation H, and other ... anal muscle Prescription creams such as nitrates or calcium channel blockers, applied over the fissure to help ...

  12. [Giant condyloma of the penis with malignant transformation associated with lichen sclerosus et atrophicus].

    PubMed

    Wessendorf, U; Bruch-Gerharz, D; Braunstein, S; Braunstein, R; Schulte, K-W; Reifenberger, J

    2009-10-01

    A 72-year old patient presented with a 6 months history of a rapidly growing tumor of the glans and foreskin. He had a long history of phimosis with lichen sclerosus et atrophicus-like lesions on the foreskin which had not been treated. The rest of the personal, family and sexual history was unremarkable. Treatment consists of circumcision and tumor excision. Histopathology confirmed a squamous cell carcinoma within a giant condyloma with a concomitant lichen sclerosus et atrophicus. CT- and ultrasound scans showed no metastases. Giant condylomas are a rare sexually transmitted disease usually caused by human papilloma virus subtypes 6, 11, but also by 16 and 18 among others. They are expansive, cauliflower-like destructive lesions that most frequently affect the anogenital region. In about 30 percent a giant condyloma progresses into a squamous cell carcinoma. Therapy of choice is the histopathologically controlled excision. Recurrences are often seen, so the patients should be monitored frequently after therapy. PMID:19756435

  13. Anal fissure

    PubMed Central

    Schlichtemeier, Steven; Engel, Alexander

    2016-01-01

    SUMMARY An anal fissure is a common, mostly benign, condition that can be acute or chronic. The diagnosis is usually made on history and physical examination, but further investigations are sometimes necessary. Primary fissures are usually benign and located in the posterior or anterior position. Secondary fissures are lateral or multiple and often indicate a more serious underlying pathology. The management of primary anal fissures is generally non-operative and includes increased dietary fibre, sitz baths, topical ointments and botulinum toxin injections. If these treatments are ineffective the patient will need a surgical referral. Secondary anal fissures require further investigation. Multidisciplinary management is preferable and is essential in the case of malignancy. PMID:27041801

  14. Anal Warts

    MedlinePlus

    ... entire pelvic region to include the vaginal or penile area to look for other warts that may require treatment. MUST I BE HOSPITALIZED FOR SURGICAL TREATMENT? Surgical treatment of anal warts is usually performed as outpatient surgery. HOW MUCH TIME WILL I LOSE FROM WORK ...

  15. Progression of Intravesical Condyloma Acuminata to Locally Advanced Poorly Differentiated Squamous Cell Carcinoma.

    PubMed

    Khambati, A; Bhanji, Y; Oberlin, D T; Yang, X J; Nadler, R B; Perry, K T; Kundu, S D

    2016-07-01

    Condyloma acuminata (CA) is a common sexually transmitted disease caused by Human Papilloma Virus (HPV) infection. CA of the bladder, however, is an exceedingly rare lesion. We present a rare case of poorly differentiated locally invasive squamous cell carcinoma (SCC) arising from recurrent CA of the bladder in an immunocompetent patient and discuss pathophysiology and management of this unusual condition. PMID:27335797

  16. [SURGICAL TREATMENT OF POSTOPERATIVE STRICTURE OF ANAL CHANNELL].

    PubMed

    Shevchuk, I M; Sadoviy, I Ya; Novytskiy, O V

    2015-09-01

    The results of treatment of 50 patients, suffering postoperative stricture of anal channell (SACH), who were treated in Proctology Department of Ivano-Frankivskiy Rural Clinical Hospital in 2006-2014 yrs, were analyzed. After conduction of hemorrhoidectomy in accordance to Milligan-Morgan method for chronic hemorrhoids grades III-IV a SACH have occurred in 46 (92%) patients, excision of a chronic anal fissura was performed in 3 (6%) and excision of perianal pointed condylomas--in 1 patient. In 2006-2007 yrs 11 (22%) patients were operated in accordance to approaches, which were conventional at that time (comparison group). In 2008 - 2014 yrs 39 (78%) patients were admitted to hospital (main group), in whom new approaches for diagnosis, conservative and surgical treatment were applied, 30 (76.9%) of them were operated. The proposed method on isolated roentgen contrast investigation of anal channell have permitted to determine objectively a form, diameter and grade of the anal channel stricture, and it may be applied as a screening procedure, as additional objective criterion while choosing a surgical tactic. Application of the improved operative technique for SACH have permitted to lower its occurrence rate from 45.4 to 6.7%. PMID:26817078

  17. Anal fissure - series (image)

    MedlinePlus

    ... rectum through which passes stool during defecation. The anal sphincter is a critical mechanism for control of ... Anal fissures are tears in the skin overlying the anal sphincter, usually due to increased tone of ...

  18. The antioxidant activities effect of neutral and acidic polysaccharides from Epimedium acuminatum Franch. on Caenorhabditis elegans.

    PubMed

    Xu, Zhou; Feng, Shiling; Shen, Shian; Wang, Handong; Yuan, Ming; Liu, Jing; Huang, Yan; Ding, Chunbang

    2016-06-25

    A neutral polysaccharide (EAP-1N) and an acidic polysaccharide (EAP-2A) were purified from Epimedium acuminatum by DEAE-52 cellulose anion-exchange chromatography and gel-filtration chromatography. Their structures were characterized by chemical composition analysis, high-performance size exclusion chromatography (HPSEC), Fourier transform infrared spectrometry (FT-IR), and gas chromatography-mass spectrometry (GC-MS). Further, their antioxidant activities were investigated both in vitro and in vivo. Results showed that EAP-2A had higher uronic acid content and larger average molecular weight than EAP-1N. Compared with EAP-1N, EAP-2A exhibited significantly scavenging activities against free radical in vitro, as well as strongly stimulating effect on antioxidant enzyme activities (including superoxide dismutases (SOD), catalases (CAT), and glutathione peroxidases (GSH-PX)) and preferably inhibitory effect on lipid peroxidation and protein carboxyl in the mode of Caenorhabditis elegans. PMID:27083801

  19. Papillary Immature Metaplasia of the Anal Canal: A Low-grade Lesion That Can Mimic a High-grade Lesion.

    PubMed

    Roberts, Jennifer M; Cornall, Alyssa M; Ekman, Deborah; Law, Carmella; Poynten, I Mary; Jin, Fengyi; Hillman, Richard J; Templeton, David J; Tabrizi, Sepehr N; Garland, Suzanne M; Thurloe, Julia K; Grulich, Andrew E; Farnsworth, Annabelle

    2016-03-01

    In a natural history study of anal human papillomavirus (HPV) infection and HPV-related lesions among homosexual men in Sydney, Australia, we identified 15 examples of papillary immature metaplasia (PIM) in anal biopsy samples. PIM has previously been described in the cervix, but not in the anal canal. PIM is a form of exophytic low-grade squamous intraepithelial lesion (eLSIL) also known as condyloma. In contrast to the maturing keratinocytes and koilocytosis seen in conventional eLSIL, the slender papillary structures of PIM have a surface population of immature squamous cells. In our anal samples PIM was characterized by close proximity to conventional eLSIL, was negative for p16 (p16) expression, and revealed the presence of a single low-risk HPV genotype (either 6 or 11) in laser capture microdissected lesions. The clinical significance of recognizing PIM lies in preventing misdiagnosis as high-grade squamous intraepithelial lesion, (the presumed precursor to anal cancer), due to the morphologic immaturity of the cell population. In routine practice, awareness of anal canal PIM and p16 immunostaining will prevent this. Further study of the natural history of anal canal PIM is needed. PMID:26551619

  20. Anal fissure - slideshow

    MedlinePlus

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

  1. Randomized clinical trial comparing systemic interferon with diathermocoagulation in primary multiple and widespread anogenital condyloma.

    PubMed

    Benedetti Panici, P; Scambia, G; Baiocchi, G; Perrone, L; Pintus, C; Mancuso, S

    1989-09-01

    Two hundred three patients (median age 26 years; range 18-45) with untreated multiple and widespread anogenital condyloma were randomly assigned to one of four study arms in order to compare the efficacy, toxicity, and tolerability of recombinant interferon alpha-2b with those of diathermocoagulation. Of 200 evaluable patients, 51 were treated intramuscularly (IM) with 3 x 10(6) U (3 MU)/m2 daily for 3 weeks (total dose 63 MU/m2), 50 received subcutaneous thrice-weekly injections of 3 MU/m2 for 4 weeks (total dose 36 MU/m2), 51 underwent diathermocoagulation, and 48 were not treated and were used as a control group. Six months after the end of treatment, the overall response rate (complete and partial responses) was 70%: 57 and 82% for patients receiving interferon alpha-2b (IM and subcutaneously) and diathermocoagulation, respectively, and 8% for the control group. After 6 months from therapy, no significant differences in complete response were found among the different types of treatment: 20, 20, and 35% for the two interferon groups and the diathermocoagulation group, respectively. Fifteen and two complete responders in the cauterization and interferon groups, respectively, experienced disease recurrence (P less than .01). All patients given interferon therapy complained of flu-like symptoms, which declined progressively after the first week of treatment. Fatigue, lasting as long as patients received interferon, was the most prevalent chronic side effect. We conclude that systemic recombinant interferon alpha-2b is active in treating patients with primary condyloma lesions and does so as well as cauterization.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2761917

  2. Giant Condyloma Acuminate Due to Human Papillomavirus Type 16 in an Infant Successfully Treated with Topical Imiquimod Therapy.

    PubMed

    Dinleyici, Meltem; Saracoglu, Nurhan; Eren, Makbule; Kiliç, Ömer; Ciftci, Evrim; Dinleyici, Ener Cagri; Sag, Cigdem; Kara, Ates

    2015-12-01

    Anogenital warts related to human papillomavirus (HPV) have been observed in children. Definition of the transmission mode, therapy, and follow-up for long term potential complications is important. A 27-month old girl was admitted with multiple pedunculated red-purple colored cauliflower-like lesions of 1.5 years duration. Clinical/histopathological and microbiological diagnosis was condyloma acuminate due to HPV type 16. After 12 weeks of imiquimod 5% cream application (pea-sized) overnight three times per week, the perianal warts had completely disappeared. The mode of transmission of HPV 16 in our case was probably horizontal, related to the sharing of common personal hygiene items in the women's shelter. We report herein the case of an infant living in a women's shelter with giant condyloma acuminata due to HPV 16, which was successfully treated with topical imiquimod therapy. This patient should be followed up for recurrence and potential malignant lesions related to HPV type 16. PMID:26734121

  3. Antiretroviral Therapy as a Factor Protective against Anal Dysplasia in HIV-Infected Males Who Have Sex with Males

    PubMed Central

    Hidalgo-Tenorio, Carmen; Rivero-Rodriguez, Mar; Gil-Anguita, Concepción; Lopez De Hierro, Mercedes; Palma, Pablo; Ramírez-Taboada, Jessica; Esquivias, Javier; López-Ruz, Miguel Angel; Javier-Martínez, Rosario; Pasquau-Liaño, Juan

    2014-01-01

    Objectives Chronic infection with oncogenic HPV genotype is associated with the development of anal dysplasia. Antiretroviral therapy (ART) has been shown to decrease the incidence of cervical carcinoma in women with HIV. We sought to: 1) describe the prevalence and grade of anal dysplasia and HPV infection in our study subjects; 2) analyze the grade of correlation between anal cytology, PCR of high-risk HPV, and histology; 3) identify the factors associated with the appearance of ≥AIN2 lesions. Design Cross-sectional, prospective study. Methods A cohort of HIV-positive males (n = 140, mean age  = 37 years) who have sex with males (MSM) had epidemiological, clinical and analytical data collected. Anal mucosa samples were taken for cytology, HPV PCR genotyping, and anoscopy for histological analysis. Results Within the cohort, 77.1% were being treated with ART, 8.5% anoscopy findings were AIN2, and 11.4% carcinoma in situ; 74.2% had high-risk (HR), 59.7% low-risk (LR) HPV genotypes and 46.8% had both. The combination of cytology with PCR identifying HR-HPV better predicts the histology findings than either of these factors alone. Logistic regression highlighted ART as a protective factor against ≥AIN2 lesions (OR: 0.214; 95%CI: 0.054–0.84). Anal/genital condylomas (OR: 4.26; 95%CI: 1.27–14.3), and HPV68 genotype (OR: 10.6; 95%CI: 1.23–91.47) were identified as risk factors. Conclusions In our cohort, ART has a protective effect against dysplastic anal lesions. Anal/genital warts and HPV68 genotype are predictors of ≥AIN2 lesions. Introducing PCR HPV genotype evaluation improves screening success over that of cytology alone. PMID:24676139

  4. What Is Anal Cancer?

    MedlinePlus

    ... anal papillae are also called fibroepithelial polyps . Skin tags: Skin tags are benign growths of connective tissue that are covered by squamous cells. Skin tags are often mistaken for hemorrhoids (swollen veins inside ...

  5. Stages of Anal Cancer

    MedlinePlus

    ... following stages are used for anal cancer: Stage 0 (Carcinoma in Situ) In stage 0 , abnormal cells ... or check-ups. Treatment Options by Stage Stage 0 (Carcinoma in Situ) Treatment of stage 0 is ...

  6. Anal Dysplasia Screening

    PubMed Central

    2007-01-01

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

  7. Treatment of condyloma acuminata in pregnant women with cryotherapy combined with proanthocyanidins: Outcome and safety

    PubMed Central

    YANG, LI-JUAN; ZHU, DONG-NING; DANG, YAN-LING; ZHAO, XIONG

    2016-01-01

    Patients with condyloma acuminata (CA) during pregnancy represent a special risk group. The outcomes of many treatment methods for such cases are not satisfactory. The purpose of the present study was to evaluate the treatment outcome and safety of cryotherapy combined with proanthocyanidins (PCs) for CA in pregnant women. In this study, 46 pregnant women with CA were treated with cryotherapy combined with PCs. The lesions were sprayed with liquid nitrogen until the color of the wart changed from flesh colored to purple. A PC-containing formulation was then sprayed onto a non-woven fabric or single-layer gauze and applied to the affected area. The PC treatment was applied for 20 min, 2 or 3 times per day. All patients were followed up at 1 and 3 months. No visible warts remained after the cryotherapy and PC treatment. At the 1-month follow-up, only 1 case of recurrence was identified. At 3 months, 5 cases of recurrence were identified, and the recurrence rate was 10.9%. The satisfaction rate of the patients was 94% at 1 month and 87% at 3 months after treatment. All pregnancies resulted in healthy live births without delivery complications. Cryotherapy combined with PCs is indicated to be a safe and effective procedure and may serve as a treatment option for pregnant women with CA. PMID:27284325

  8. Treatment of vulvar/vaginal condyloma by HPV: developed instrumentation and clinical report

    NASA Astrophysics Data System (ADS)

    Inada, N. M.; Kurachi, C.; Ferreira, J.; Ribeiro, E. S.; Guimarães, O. C. C.; Quintana, S. M.; Lombardi, W.; Bagnato, V. S.

    2009-06-01

    Human papillomavirus (HPVs) are a family of sexually viruses with over 100 different genotypes identified till date. They are associated in 99% of cervical cancers, with HPV16 found in about 50% of cases. They are a cause of the second most common female cancer worldwide. PDT may constitute an alternative treatment for condyloma by HPV. In this work we present the development of a PDT device specifically designed for the treatment of vulvar and vaginal lesions induced by HPV. This equipment has been used in a clinical protocol and it is optically based on 640 nm LED (light emitting diodes) arrays. There are three illumination probes available that were anatomically designed for specific site applications: a 30 mm x 115 mm diffuser cylinder for intravaginal illumination and uniform irradiance of 42 mW/cm2; a 36 mm circular probe with 118 mW/cm2 and a 74 mm circular probe with 57 mW/cm2, both for external illumination. The 10% aminolevulinic acid cream is topically placed over the lesions and 4-6 hours after the application the illumination is performed. The illumination time is set depending on the chosen probe and treatment area to achieve a fluence of 200 J/cm2. In this presentation, the preliminary results of this clinical trial will be presented.

  9. Isolation of a novel human papillomavirus (type 51) from a cervical condyloma

    SciTech Connect

    Nuovo, G.J.; Crum, C.P.; Levine, R.U.; Silverstein, S.J. ); De Villiers, E.M. )

    1988-04-01

    The authors cloned the DNA from a novel human papillomavirus (HPV) present in a cervical condyloma. When DNA from this isolate was hybridized at high stringency with HPV types 1 through 50 (HPV-1 through HPV-50), it showed weak homology with HPV-6 and -16 and stronger homology with HPV-26. A detailed restriction endonuclease map was prepared which showed marked differences from the maps for other HPVs that have been isolated from the female genital tract. Reassociation kinetic analysis revealed that HPV-26 and this new isolate were less than 10% homologous; hence, the new isolate is a noel strain of HPV. The approximate positions of the open reading frames of the new strain were surmised by hybridization with probes derived from individual open reading frames of HPV-16. In an analysis of 175 genital biopsies from patients with abnormal Papanicolaou smears, sequences hybridizing under highly stringent conditions to probes from this novel HPV type were found in 4.2, 6.1, and 2.4% of biopsies containing normal squamous epithelium, condylomata, and intraepithelial neoplasia, respectively. In addition, sequences homologous to probes from this novel isolate were detected in one of five cervical carcinomas examined.

  10. Immunohistochemical aspects of apoptosis in gingival mucosa with papilloma and condyloma acuminata.

    PubMed

    Scrieciu, Monica; Mercuţ, Veronica; Mercuţ, Răzvan; Amărăscu, Marina Olimpia; Popescu, Sanda Mihaela; Predescu, Anca Mihaela; Baniţă, Ileana Monica

    2015-01-01

    The oral mucosa is a component of the oral ecosystem, which can be aggressed by corrosion products released from the dental alloys used in prosthetic dentistry therapy. The purpose of this study was to compare the in vivo effect of nickel and copper compounds on the oral mucosa cells, including their ability to induce cell death, by analyzing the cytochrome c (cyt. c) immunohistochemical expression. Gingival mucosa fragments obtained from the subjects with dentures manufactured by nickel or copper casting alloys were processed through the histological technique of paraffin inclusion. The sections obtained were stained by usually histological methods in order to highlight the histopathological lesions and also analyzed using the immunohistochemical technique in order to study the cyt. c expression. The papillomatosis lesions were observed in the gingival mucosa fragments obtained from the subjects with nickel-based alloy dentures and the condyloma acuminata lesions were observed in those obtained from the subjects with copper-based alloy dentures. The cyt. c immunohistochemical expression was different in the epithelial layer of two types of mucosal fragments but it was the same in their lamina propria connective tissue. We can conclude that the two types of metal alloys have different effects on the adjacent gingival mucosa. PMID:26193209

  11. Surgical management of a giant condyloma of Buschke-Löwenstein in a patient with Netherton syndrome using the pedicled anterolateral thigh flap--a case report.

    PubMed

    Li, Adrienne L K; Walsh, Scott; McKay, Douglas R

    2011-11-01

    The surgical management of a giant condyloma of Buschke and Löwenstein poses particular reconstructive challenges, given the wound size, depth, and infection risk. We present a case where a pedicled anterolateral thigh flap is used to reconstruct a complex wound following resection of a giant condyloma of Buschke and Löwenstein arising in a patient with Netherton syndrome. Our operative technique re-iterates the utility of this flap in perineal reconstruction and demonstrates the possibility for an 18 cm wide arc of rotation. To our knowledge, this is the first report of a successful complex excision of a giant condyloma in Netherton syndrome, the subsequent reconstruction, and periodic maintenance with topical therapies. PMID:21463975

  12. Heterosexual anal sexuality and anal sex behaviors: a review.

    PubMed

    McBride, Kimberly R; Fortenberry, J Dennis

    2010-03-01

    Little research addresses the role of anal sexuality and anal sexual behaviors as a widely practiced but relatively less frequent element of a heterosexual sexual repertoire. However, the importance of anal sex in sexual health is increasingly well-defined by epidemiological and clinical studies. This article reviews existing data on a range of heterosexual anal sex practices and provides conceptual and methodological recommendations for new research. PMID:20358456

  13. Anal itching - self-care

    MedlinePlus

    Anal itching occurs when the skin around your anus becomes irritated. You may feel intense itching around ... Anal itching may be caused by: Spicy foods, caffeine, alcohol, and other irritating foods and beverages Scents ...

  14. [Anal intraepithelial neoplasia].

    PubMed

    de Parades, Vincent; Fathallah, Nadia; Barret, Maximilien; Zeitoun, Jean-David; Lemarchand, Nicolas; Molinié, Vincent; Weiss, Laurence

    2013-01-01

    Anal intraepithelial lesions are caused by chronic infection with oncogenic types of human papillomavirus. Their incidence and prevalence are increasing, especially among patients with HIV infection. Their natural history is not well known, but high-grade intraepithelial lesions seem to have an important risk to progress to squamous cell carcinoma. Their treatment can be achieved by many ways (surgery, coagulation, imiquimod, etc.) but there is a high rate of recurrent lesions. Pretherapeutic evaluation should benefit from high-resolution anoscopy. Periodic physical examination and anal cytology may probably be interesting for screening the disease among patients with risk factors. Vaccine against oncogenic types of papillomavirus may prevent the development of anal intraepithelial neoplasia. PMID:23122632

  15. Serological test results of sexually transmitted diseases in patients with condyloma acuminata

    PubMed Central

    Gönül, Müzeyyen; Çakmak, Seray; Yalçınkaya Iyidal, Ayşegül; Kılıç, Arzu; Gül, Ülker; Doner, Pinar

    2015-01-01

    Introduction Human papillomavirus (HPV) is one of the most common causes of sexually transmitted diseases (STD). The incidence of condyloma acuminata (CA) has increased in recent years. Aim To determine demographical features and serological test results of STD in patients with CA. Material and methods A cross-sectional survey was conducted on 94 patients presenting to a dermatology clinic in Ankara, Middle Anatolia, Turkey. Dermatological examinations were made and the patients completed a questionnaire which consisted of questions about their marital status, partners and condom use. In all cases, VDRL/RPR, anti-HIV, HBsAg, anti-HCV and in 57 cases – HSV type 1–2 IgM and IgG were studied. If the value of VDRL or RPR was positive, TPHA was conducted. Results In our study, 83 men and 11 women had CA. We could not analyze whether our cases had multiple partners and a habit of condom use as some of the patients did not answer questions about their sexual life. We observed VDRL and TPHA positivity in 3 (3.1%) cases, none of those cases had clinical findings of syphilis and they denied using any therapy for syphilis. HBsAg positivity was found in 3 cases. No anti-HIV and anti-HCV antibody positivity was detected. Conclusions The seroprevalence of HBsAg in our study was similar to that of the general population of Turkey. But as we found positive syphilis serology in 3 patients, we suggest that syphilis serology should be investigated in patients with CA. PMID:26366153

  16. Characterisation of New Zealand Fusarium populations using a polyphasic approach differentiates the F. avenaceum/F. acuminatum/F. tricinctum species complex in cereal and grassland systems.

    PubMed

    Harrow, Sally A; Farrokhi-Nejad, Reza; Pitman, Andrew R; Scott, Ian A W; Bentley, Alison; Hide, Charlotte; Cromey, Matthew G

    2010-04-01

    The purpose of this study was to determine the diversity and prevalence of Fusarium species in a survey of cereal and grassland systems from the South Island of New Zealand by applying morphological and molecular techniques. Isolates were collected from soil, roots, and stems from 21 cereal and grassland sites. Ten Fusarium species were identified using morphological characters, including F. acuminatum, F. avenaceum, F. crookwellense, F. culmorum, F. equiseti, F. oxysporum, F. poae, F. pseudograminearum, F. sambucinum, and F. tricinctum. In general, their distribution was found to be unrelated to biogeographical location, although agricultural practice increased the overall diversity of Fusarium. Phylogenetic analyses were successfully used to identify morphologically similar isolates belonging to the F. avenaceum/F. acuminatum/F. tricinctum species complex and to resolve previously undetermined relationships amongst these species. Fifty-eight isolates classified as either F. avenaceum, F. acuminatum, or other closely related species as well as several well-characterised isolates from international culture collections were examined using DNA sequence data for β-tubulin (βTUB), translation elongation factor 1α (EF1α), and mitochondrial small subunit ribosomal RNA (mtSSU). Analyses of DNA sequence data from both βTUB and EF1α discriminated among isolates of F. avenaceum, F. acuminatum, and F. tricinctum and determined that these three distinct sequence groups formed a single clade. By contrast, mtSSU was unable to differentiate F. avenaceum from F. acuminatum and other closely related species believed to be F. tricinctum. Comparison of the EF1α sequences with the international FUSARIUM-ID database supported the identification of isolates in this study. As in other studies, F. avenaceum was found to be widespread in agricultural and native ecosystems. However, F. acuminatum in New Zealand was found only on non-wheat hosts. The reason for the absence of this

  17. Encopresis and anal masturbation.

    PubMed

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

    2000-01-01

    Current pediatric and psychiatric studies on encopresis and its treatment are heavily influenced by mechanical, physiological, and behavioral considerations. Although psychodynamic treatment has generally been considered to be of little benefit, and its findings suspect, the authors suggest that a psychodynamic approach adds substantially to the understanding of some cases of encopresis; that the anal sensations and anal erotic feelings reported by a number of encopretic children are intense, and that the encopretic symptom, soiling, in these children is the result of a conscious form of anal masturbation in which the fecal mass is used for stimulation; and that any study of encopresis is incomplete that does not include what encopretic children, engaged in a sound therapeutic relationship, know and say about their soiling. The authors further suggest that physical treatments of those children whose encopresis is psychologically driven may be contraindicated. The presence of a large stool does not in itself substantiate a physical illness. Further research is needed to elucidate the prevalence of anal masturbation in encopretic children. PMID:11212192

  18. Giant Condyloma Acuminate Due to Human Papillomavirus Type 16 in an Infant Successfully Treated with Topical Imiquimod Therapy

    PubMed Central

    Dinleyici, Meltem; Saracoglu, Nurhan; Eren, Makbule; Kiliç, Ömer; Ciftci, Evrim; Sag, Cigdem; Kara, Ates

    2015-01-01

    Anogenital warts related to human papillomavirus (HPV) have been observed in children. Definition of the transmission mode, therapy, and follow-up for long term potential complications is important. A 27-month old girl was admitted with multiple pedunculated red-purple colored cauliflower-like lesions of 1.5 years duration. Clinical/histopathological and microbiological diagnosis was condyloma acuminate due to HPV type 16. After 12 weeks of imiquimod 5% cream application (pea-sized) overnight three times per week, the perianal warts had completely disappeared. The mode of transmission of HPV 16 in our case was probably horizontal, related to the sharing of common personal hygiene items in the women’s shelter. We report herein the case of an infant living in a women’s shelter with giant condyloma acuminata due to HPV 16, which was successfully treated with topical imiquimod therapy. This patient should be followed up for recurrence and potential malignant lesions related to HPV type 16. PMID:26734121

  19. [Death after anal "fisting"].

    PubMed

    Preuss, Johanna; Strehler, Marco; Dettmeyer, Reinhard; Madea, Burkhard

    2008-01-01

    A 45-year-old homeless woman was found dead at her usual sleeping place. Apart from traces of blood on the lower abdomen of the body, the police investigations did not produce any clues pointing to an unnatural death. At autopsy, it was found, however, that death had been caused by extensive disruptions of the intestine. After being confronted with the results, the sexual partner of the victim admitted manual anal penetration, but claimed that this had been done by mutual agreement. The court did not accept that statement and sentenced him to life imprisonment for murder. The frequency of such fatal outcomes of anal penetration, the relationship between the perpetrator and the victim and the special features at the scene are discussed. PMID:18389861

  20. Screening for Anal Cancer in Women

    PubMed Central

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

    2015-01-01

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

  1. Do We Know What Causes Anal Cancer?

    MedlinePlus

    ... anal cancer be prevented? Do we know what causes anal cancer? Researchers have found some risk factors that increase ... now being done to learn how HPV might cause anal cancer. There is good evidence that HPV causes many ...

  2. Can Anal Cancer Be Found Early?

    MedlinePlus

    ... Next Topic Signs and symptoms of anal cancer Can anal cancer be found early? Many anal cancers can be found early in the course of the ... they reach an advanced stage. Other anal cancers can cause symptoms like those of diseases other than ...

  3. Black Anal Canal: Acute Necrosis

    PubMed Central

    Martins, Catarina; Gonçalves, Cláudia; Alves, Paulo; Gil, Inês; Canhoto, Manuela; Silva, Filipe; Cotrim, Isabel; Amado, Cristina; Eliseu, Liliana; Vasconcelos, Helena

    2016-01-01

    Acute ischemia of the rectum or anal canal resulting in necrosis is extremely uncommon because both the rectum and the anal canal have excellent blood supplies. We present a case with spontaneous necrosis of the anal canal without rectal involvement. Surgical debridement was accomplished, and the recovery was uneventful. The patient was elderly, with probable atherosclerotic arterial disease, and presented with hypotension. Due to the lack of other precipitating factors, the hypoperfusion hypothesis seems to be the most suitable in this case. To the best of our knowledge, no similar cases have been reported in the literature on this subject.

  4. Anal Pap smears and anal cancer: what dermatologists should know.

    PubMed

    Liszewski, Walter; Ananth, Amy T; Ploch, Lauren E; Rogers, Nicole E

    2014-11-01

    Squamous epithelial cells are susceptible to infection by the human papillomavirus. Infection of squamous epithelium with oncogenic human papillomavirus types is associated with development of dysplasia and potential malignant transformation. Historically, cervical cancer has been the most prevalent human papillomavirus-induced squamous neoplasia. However, because of widespread screening via Pap smear testing, rates of cervical cancer in the United States have decreased dramatically during the past 50 years. Rates of anal cancer, in contrast, have doubled during the past 30 years. The groups at highest risk for development of anal cancer are men who have sex with men, HIV-positive patients, and patients immunosuppressed as a result of solid-organ transplantation. By detecting dysplasia before it develops into invasive cancer, anal Pap smears may be a potentially useful screening tool for anal cancer, particularly in individuals known to be at increased risk. However, at this time, sufficient data supporting the benefit of anal Pap smear screening are lacking. With insufficient evidence, no national health care organizations currently recommend the use of anal Pap smears as a routine screening test, even among high-risk groups. PMID:25088812

  5. [HPV-induced anal lesions].

    PubMed

    Wieland, U; Kreuter, A

    2015-06-01

    Human papillomavirus (HPV) infections belong to the most common sexually transmitted infections. To date, more than 200 completely classified HPV-types have been reported, and those belonging to the genus alpha predominantly infect the anogenital region. Condylomata acuminata are caused by the two low-risk types HPV6 and HPV11 in more than 90 % of cases. Treatment of genital warts might be either ablative (e.g. electrocautery, surgical excision, or laser therapy) or topical (e.g. podophyllotoxine, trichloroacetic acid, or imiquimod), and depends on the size, location, morphology and anatomical region. Recurrences after treatment are frequent. Therefore, combination therapies (e.g. topical and ablative) play an important role in daily routine. HIV-infected individuals, especially HIV-positive MSM, have a strongly increased risk for anal dysplasia and anal cancer. Condylomata acuminata and a large proportion of anal dysplasia and anal carcinoma are preventable by prophylactic HPV-vaccination. PMID:25859930

  6. Electrocautery for Precancerous Anal Lesions

    Cancer.gov

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

  7. Modern management of anal fistula

    PubMed Central

    Limura, Elsa; Giordano, Pasquale

    2015-01-01

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

  8. Modern management of anal fistula.

    PubMed

    Limura, Elsa; Giordano, Pasquale

    2015-01-01

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

  9. Sphincteroplasty for anal incontinence

    PubMed Central

    Pescatori, Lorenzo Carlo; Pescatori, Mario

    2014-01-01

    Sphincteroplasty (SP) is the operation most frequently performed in patients suffering from moderate-to-severe anal incontinence (AI) who do not respond to conservative treatment. Other costly surgeries, such as artificial bowel sphincter (ABS) and electro-stimulated graciloplasty, have been more or less abandoned due to their high morbidity rate. Minimally invasive procedures are widely used, such as sacral neuromodulation and injection of bulking agents, but both are costly and the latter may cure only mild incontinence. The early outcome of SP is usually good if the sphincters are not markedly denervated, but its effect diminishes over time. SP is more often performed for post-traumatic than for idiopathic AI. It may also be associated to the Altemeier procedure, aimed at reducing the recurrence rate of rectal prolapse, and may be useful when AI is due either to injury to the sphincter, or to a narrowed rectum following the procedure for prolapse and haemorrhoids (PPH) and stapled transanal rectal resection (STARR). The outcome of SP is likely to be improved with biological meshes and post-operative pelvic floor rehabilitation. SP is more effective in males than in multiparous women, whose sphincters are often denervated, and its post-operative morbidity is low. In conclusion, SP, being both low-cost and safe, remains a good option in the treatment of selected patients with AI. PMID:24759337

  10. Conservative treatment for anal incontinence

    PubMed Central

    Carter, Dan

    2014-01-01

    Anal incontinence (AI) in adults is a troublesome condition that negatively impacts upon quality of life and results in significant embarrassment and social isolation. The conservative management of AI is the first step and targets symptomatic relief. The reported significant improvement with conservative treatments for AI is close to 25% and involves prescribed changes in lifestyle habits, a reduced intake of foods that may cause or aggravate diarrhea or rectal urgency, and the use of specific anti-diarrheal agents. The use of a mechanical barrier in the form of an anal plug and the outcomes and principles of pelvic kinesitherapies and biofeedback options are outlined. This review discusses a gastroenterologist's approach towards conservative therapy in patients referred with anal incontinence. PMID:24759347

  11. Cisplatin and Fluorouracil Compared With Carboplatin and Paclitaxel in Treating Patients With Inoperable Locally Recurrent or Metastatic Anal Cancer

    ClinicalTrials.gov

    2016-03-22

    Anal Basaloid Carcinoma; Anal Canal Cloacogenic Carcinoma; Anal Squamous Cell Carcinoma; Metastatic Anal Canal Carcinoma; Recurrent Anal Canal Carcinoma; Stage IIIB Anal Canal Cancer; Stage IV Anal Canal Cancer

  12. Internal anal sphincter: an anatomic study.

    PubMed

    Uz, A; Elhan, A; Ersoy, M; Tekdemir, I

    2004-01-01

    The anatomy of the internal anal sphincter and surrounding structures was investigated in 24 cadavers using a surgical microscope (6-25 x magnification). An understanding of the anatomy of the internal anal sphincter is helpful in avoiding complications during surgical procedures in the anorectal region. The external anal sphincter was composed of three ellipsoid rings of skeletal muscle (subcutaneous, superficial, and deep) that encircle the anal canal; in contrast, we found that the internal anal sphincter was composed of flat rings of smooth muscle bundles stacked one on top of the other, like the slats of a Venetian blind. In each anal canal, the average number of ring-like slats observed was 26.33 +/- 2.93 (range = 20-30) and each was covered by its own fascia. The smooth muscle fibers and fascia coalesced at three equidistant points around the anal canal to form three columns that extended distally into the lumen and differed in form from the other anal columns. When viewed from an anterior position, the columns were located anteriorly at the observer's right (5 o'clock position), posteriorly at the right (1 o'clock position), and laterally at the left (9 o'clock position). This heretofore unreported anatomy of the internal anal sphincter may play an important role in closing off the lumen of the anal canal and maintaining bowel continence. PMID:14695582

  13. Conservative management of anal leiomyosarcoma

    SciTech Connect

    Minsky, B.D.; Cohen, A.M.; Hajdu, S.I. )

    1991-10-01

    Leiomyosarcomas of the large intestine are unusual neoplasms, comprising less than 0.1% of all malignancies of the colon and rectum. Six cases of leiomyosarcoma of the anus have been reported. The optimal treatment for this neoplasm is not known. The standard surgical approach is abdominoperineal resection. The authors report the seventh case of this rare neoplasm and outline its treatment using local excision and iridium 192 brachytherapy in an attempt to preserve the anal sphincter. In selected patients, conservative surgery followed by radiation therapy may be an alternative to radical surgery, with the goals of local control of the disease and anal sphincter preservation. However, more experience is needed before this approach could be recommended routinely.

  14. [Anal cancer in HIV patients].

    PubMed

    Quéro, Laurent; Duval, Xavier; Abramowitz, Laurent

    2014-11-01

    Despite effective highly active antiretroviral treatment, anal cancer incidence has recently strongly increased in HIV-infected population. Treatment strategy in HIV-infected patients does not differ from general population. HIV-infected patients treated by chemo-radiotherapy are exposed to high-grade toxicities and should be closely monitored to deliver the optimal treatment. Close collaboration between oncologist and infectiologist is highly recommended to adjust antiretroviral therapy if necessary. PMID:25418596

  15. Elements of an anal dysplasia screening program.

    PubMed

    Jay, Naomi

    2011-01-01

    The incidence of anal cancer in HIV-infected men who have sex with men (MSM) is highly elevated compared to the general population, as is the incidence of its precursor lesion, high-grade anal intraepithelial neoplasia (HGAIN). MSM in general and other immunocompromised populations are also at higher risk. Treatment of HGAIN may prevent development of cancer, similar to the decrease in cervical cancers that has occurred since the advent of cervical cancer screening programs in women. Cervical cancer screening tools have been adapted and validated for screening, diagnosis, and treatment of anal HGAIN. Anal cancer screening programs have now been available for more than a decade, although they are not yet standards of care. Incorporating screening procedures into practice depends on the available resources in a particular community. This article discusses the procedures for anal cancer screening including cytology, digital anal rectal examinations, high-resolution anoscopy, and biopsy. PMID:22035526

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

    PubMed

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

    2016-09-01

    Chronic anal fissure is a painful disorder caused by linear ulcers in the distal anal mucosa. Even though it counts as one of the most common benign anorectal disorders, its precise etiology and pathophysiology remains unclear. Current thinking is that anal fissures are caused by anal trauma and pain, which leads to internal anal sphincter hypertonia. Increased anal basal pressure leads to diminished anodermal blood flow and local ischemia, which delays healing and leads to chronic anal fissure. The current treatment of choice for chronic anal fissure is either lateral internal sphincterotomy or botulinum toxin injections. In contrast to current thinking, we hypothesize that the external, rather than the internal, anal sphincter is responsible for increased anal basal pressure in patients suffering from chronic anal fissure. We think that damage to the anal mucosa leads to hypersensitivity of the contact receptors of the anal-external sphincter continence reflex, resulting in overreaction of the reflex. Overreaction causes spasm of the external anal sphincter. This in turn leads to increased anal basal pressure, diminished anodermal blood flow, and ischemia. Ischemia, finally, prevents the anal fissure from healing. Our hypothesis is supported by two findings. The first concerned a chronic anal fissure patient with increased anal basal pressure (170mmHg) who had undergone lateral sphincterotomy. Directly after the operation, while the submucosal anesthetic was still active, basal anal pressure decreased to 80mmHg. Seven hours after the operation, when the anesthetic had completely worn off, basal anal pressure increased again to 125mmHg, even though the internal anal sphincter could no longer be responsible for the increase. Second, in contrast to previous studies, recent studies demonstrated that botulinum toxin influences external anal sphincter activity and, because it is a striated muscle relaxant, it seems reasonable to presume that it affects the striated

  17. Anal intraepithelial neoplasia: review and recommendations for screening and management.

    PubMed

    Smyczek, Petra; Singh, Ameeta E; Romanowski, Barbara

    2013-11-01

    Anal cancer is a rare malignancy of the distal gastrointestinal tract, often associated with human papillomavirus, the most common sexually transmitted infection worldwide. Currently available screening methods for anal intraepithelial neoplasia, a precursor for anal cancer, combine anal Papanicolaou cytology and high resolution anoscopy with biopsy of suspicious lesions. Significant barriers to establishing anal cancer screening programmes include the small number of healthcare professionals performing high resolution anoscopy and the lack of data showing that anal cancer screening can reduce morbidity and mortality related to anal carcinoma. Despite several controversies surrounding anal cancer screening, the rising incidence of this disease in some groups supports routine screening programmes in high-risk populations, especially in HIV-positive men who have sex with men. This review outlines the epidemiology of anal intraepithelial neoplasia and anal cancer and summarizes issues related to the introduction of anal cancer screening programmes. PMID:23970583

  18. Genital Warts (Condyloma Acuminata)

    MedlinePlus

    ... usually for large amounts of warts. Laser treatment – Carbon dioxide laser treatment is useful for a large amount of urethral or vaginal warts. Most of these treatments require multiple applications. If there is no improvement after 3 treatment cycles or if the warts are not gone after ...

  19. New Techniques for Treating an Anal Fistula

    PubMed Central

    2012-01-01

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

  20. Prophylactic HPV vaccination and anal cancer.

    PubMed

    Stier, Elizabeth A; Chigurupati, Nagasudha L; Fung, Leslie

    2016-06-01

    The incidence of anal cancer is increasing. High risk populations include HIV-positive men who have sex with men (MSM), HIV-negative MSM, HIV-positive women and heterosexual men and women with a history of cervical cancer. HPV has been detected in over 90% of anal cancers. HPV16 is the most common genotype detected in about 70% of anal cancers. The quadrivalent HPV (qHPV) vaccine has been demonstrated to prevent vaccine associated persistent anal HPV infections as well as anal intraepithelial neoplasia grades 2-3 (AIN2+) in young MSM not previously infected. A retrospective analysis also suggests that qHPV vaccination of older MSM treated for AIN2+ may significantly decrease the risk of recurrence of the AIN2+. The HPV types detected in anal cancer are included in the 9-valent vaccine. Thus, the 9-valent HPV vaccine, when administered to boys and girls prior to the onset of sexual activity, should effectively prevent anal cancer. PMID:26933898

  1. Anal Cancer: What Happens After Treatment?

    MedlinePlus

    ... this phase of your treatment. For patients with colostomies Most people treated for anal cancer don’t ... APR, you will need to have a permanent colostomy. If you have a colostomy, follow-up is ...

  2. Treatment Options by Stage (Anal Cancer)

    MedlinePlus

    ... following stages are used for anal cancer: Stage 0 (Carcinoma in Situ) In stage 0 , abnormal cells ... or check-ups. Treatment Options by Stage Stage 0 (Carcinoma in Situ) Treatment of stage 0 is ...

  3. Anal Disorders - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Anal Disorders URL of this page: https://medlineplus.gov/languages/analdisorders.html Other topics A-Z A B ...

  4. Anal Disorders - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Anal Disorders URL of this page: https://www.nlm.nih.gov/medlineplus/languages/analdisorders.html Other topics A-Z A B ...

  5. Neural control of internal anal sphincter function.

    PubMed

    Lubowski, D Z; Nicholls, R J; Swash, M; Jordan, M J

    1987-08-01

    The effect on anal tone of electrical stimulation of the presacral (hypogastric) sympathetic nerves has been studied in eight patients during abdominal rectopexy or restorative proctocolectomy. A sharp fall in anal pressure occurred in seven patients (mean fall 59 cmH2O; range 35-80 cmH2O). In one patient given a beta- and alpha-sympathetic blocking drug (labetalol 200 mg) intra-operatively, the anal pressure decreased by 15 cmH2O. These observations show that stimulation of the presacral sympathetic nerves causes relaxation of the internal anal sphincter and implies that these nerves may induce relaxation of the sphincter in vivo. The pathway of the recto-anal reflex has been studied intra-operatively in three patients undergoing rectal excision. The recto-anal reflex is present after presacral nerve blockade and after full mobilization of the rectum, but is abolished by circumferential rectal myotomy. The reflex has a local intramural pathway. This observation validates the assumption that absence of this reflex is a feature of aganglionosis, as in Hirschsprung's disease. PMID:3651766

  6. What's New in Anal Cancer Research and Treatment?

    MedlinePlus

    ... Next Topic Additional resources for anal cancer What’s new in anal cancer research and treatment? Important research ... cancer cells is expected to help scientists develop new drugs to fight this disease. Early detection Ongoing ...

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

    NASA Astrophysics Data System (ADS)

    Ji, Bingzhi

    1993-03-01

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

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

    ERIC Educational Resources Information Center

    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,…

  9. [Prevalence of high risk oncogen HPV by in situ hybridization and by PCR in condyloma acuminata in the region of the Tunisian Center].

    PubMed

    Nabi, Souad; Trimeche, Mounir; Ziadi, Sonia; Baccouche, Dorra; Amara, Khaled; Mestiri, Sarra; Hmissa, Sihem; Gaddas, Naim; Mokni, Moncef; Toumi, Intissar; Korbi, Sadok

    2006-03-01

    The aim of this study was to evaluate the frequency of "high-risk" HPV types in condyloma acuminata in patients from Tunisian Center. Thirty two paraffin-embedded biopsies were analysed for the presence and type of HPV DNA by means of in situ hybridization (ISH) and polymerase chain reaction (PCR) techniques. ISH was done using a broad spectrum HPV biotinylated DNA probe for the detection of HPV DNA. HPV typing was carried out using specific probes for HPV types 6/11, 16/18 and 31/33. HPV DNA was amplified by PCR using the degenerate primers E1350L/E1547. HPV were typed by pU-1M/PU-2R primers for the oncogenic HPV types 16, 18, 31 and 33, and PU-31B/PU-2R for "low-risk" group (6 and 11). Using ISH, HPV was detected in 27 out 32 cases (84.4%). All were HPV 6/11 positive. Co-infection with oncogenic HPV was found in one case that reacted with 16/18 and 31/33 probes. Good quality DNA was obtained in 13 cases. HPV was detected by PCR in 11 of 13 specimens (80.6%) when E1350L/E1547 primers were used. HPV 6/11 were present in all cases. The results of this study provide specific confirmation of the predominance of HPV6/11 and low rate of co-infection in patient from Tunisian Center. Because of the difficulty of DNA extraction, risk of DNA degradation and contamination associated with PCR, the ISH remains more adapted to archival materiel especially in routine clinical practice. PMID:16755958

  10. p16 Is Superior to ProEx C in Identifying High-grade Squamous Intraepithelial Lesions (HSIL) of the Anal Can

    PubMed Central

    Bala, Rajeev; Pinsky, Benjamin A.; Beck, Andrew H.; Kong, Christina S.; Welton, Mark L.; Longacre, Teri A.

    2016-01-01

    Although the incidence of human papillomavirus (HPV)-associated anal neoplasia is increasing, interobserver and intraobserver reproducibility in the grading of biopsy specimens from this area remains unacceptably low. Attempts to produce a more reproducible grading scheme have led to the use of biomarkers for the detection of high-risk HPV (HR-HPV). We evaluated the performance of standard morphology and biomarkers p16, ProEx C, and Ki-67 in a set of 75 lesions [17 nondysplastic lesions, 23 low-grade squamous intraepithelial lesions (LSIL)/condyloma, 20 high-grade squamous intraepithelial lesions (HSIL), 15 invasive squamous cell carcinomas] from the anal and perianal region in 65 patients and correlated these findings with HPV subtype on the basis of a type-specific multiplex real-time polymerase chain reaction assay designed to detect HR-HPV. A subset of cases with amplifiable HPV DNA was also sequenced. HSIL was typically flat (15/20), and only a minority (4/20) had koilocytes. In contrast, only 1 LSIL was flat (1/23), and the remainder were exophytic. The majority of LSIL had areas of koilocytic change (20/23). HR-HPV DNA was detected in the majority (89%) of invasive carcinomas and HSIL biopsies, 86% and 97% of which were accurately labeled by strong and diffuse block-positive p16 and ProEx C, respectively. LSIL cases, however, only infrequently harbored HR-HPV (13%); most harbored low-risk HPV (LR-HPV) types 6 and 11. Within the LSIL group, p16 outperformed ProEx C, resulting in fewer false-positive cases (5% vs. 75%). Ki-67 was also increased in HR-HPV-positive lesions, although biopsies with increased inflammation and reactive changes also showed higher Ki-67 indices. These data suggest that strong and diffuse block-positive nuclear and cytoplasmic labeling with p16 is a highly specific biomarker for the presence of HR-HPV in anal biopsies and that this finding correlates with high-grade lesions. PMID:23552383

  11. Midwestern Rural Adolescents' Anal Intercourse Experience

    ERIC Educational Resources Information Center

    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…

  12. Study of Operated Patients of Lateral Internal Anal Sphincterotomy for Chronic Anal Fissure

    PubMed Central

    Patel, Harshad Shankarlal; Chavda, Jagdish; Parikh, Jayesh; Naik, Nehal

    2013-01-01

    Introduction: Anal fissure causes significant morbidity in the population. It is proposed that elevated sphincter pressures may cause ischaemia of the anal lining and this may be responsible for the pain of anal fissures and their failure to heal. When pharmacologic therapy fails or fissures recur frequently, lateral internal sphincterotomy is the surgical treatment of choice. Material and Methods: Retrospective analysis was done of admitted and operated patients of anal fissure by lateral anal internal sphincterotomy either by open or closed technique between April 2010 and November 2011 in Gujarat Medical Education & Research Society Medical College, Sola, Ahmedabad, India. The follow-up data of all patients was evaluated for pain relief, recurrence, wound infection, incontinence to flatus or stool or both for a period of up to 6 months. Results: Wound infection rate was 10.3% in open method and 4.2% in closed method. Incontinence to flatus was 8.3% in closed method and 3.4% in open method. This was temporary and controlled within a 1 week. Incontinence to stool was 3.4% in open method which was temporary and controlled within 2 weeks while none in closed method. None of the patients in either group had come with recurrence within 6 months follow-up. Conclusion: Lateral anal internal sphincterotomy is safe regarding long term incontinence and effective regarding recurrence. PMID:24551659

  13. Prevalence and Risk Indicators for Anal Incontinence among Pregnant Women

    PubMed Central

    Skjeldestad, Finn Egil; Sandvik, Leiv

    2013-01-01

    The aim of this study was to assess the prevalence and risk factors of anal incontinence in an unselected pregnant population at second trimester. A survey of pregnant women attending a routine ultrasound examination was conducted in a university hospital in Oslo, Norway. A questionnaire consisting of 105 items concerning anal incontinence (including St. Mark's score), urinary incontinence, medication use, and comorbidity was posted to women when invited to the ultrasound examination. Results. Prevalence of self-reported anal incontinence (St. Mark's score ≥ 3) was the lowest in the group of women with a previous cesarean section only (6.4%) and the highest among women with a previous delivery complicated by obstetric anal sphincter injury (24.4%). Among nulliparous women the prevalence of anal incontinence was 7.7% and was associated to low educational level and comorbidity. Prevalence of anal incontinence increased with increasing parity. Urinary incontinence was associated with anal incontinence in all parity groups. Conclusions. Anal incontinence was most frequent among women with a history of obstetric anal sphincter injury. Other obstetrical events had a minor effect on prevalence of anal incontinence among parous women. Prevention of obstetrical sphincter injury is likely the most important factor for reducing bothersome anal incontinence among fertile women. PMID:23819058

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

    PubMed

    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

  15. Internal anal sphincter augmentation and substitution

    PubMed Central

    de la Portilla, Fernando

    2014-01-01

    There is an increasing recognition of the importance of internal anal sphincter (IAS) dysfunction presenting as passive faecal incontinence. This problem may manifest after anal sphincterotomy or following the more minimally invasive operations for haemorrhoids, as well as with advancing age. Because of the poor results of IAS plication and the beneficial outcomes with peri-urethral bulking agents in urology, these materials have been developed for use in IAS dysfunction. This review outlines the basic purported mechanisms of action, defining the materials in clinical use, their methods of deployment, complications and reported outcomes. There is still much that is unknown concerning the ideal agent or the volume and the technique of deployment, which will only be answered by powerful, prospective, randomized, controlled trials. The specific role of autologous stem cells designed to regenerate the sphincters in cases of functional impairment or muscle loss is yet to be seen. PMID:24759338

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

    PubMed Central

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

    2013-01-01

    Background. Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)–infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM. Methods. Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer. Results. Low CD4 count (<350 cells/mm3) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.28–10.40 and OR, 4.24; 95% CI, 1.16–15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43–5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection. Conclusions. We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression. PMID:23908478

  17. Anal intraepitelial neoplasia: A narrative review.

    PubMed

    Elorza, Garazi; Saralegui, Yolanda; Enríquez-Navascués, Jose María; Placer, Carlos; Velaz, Leyre

    2016-01-01

    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. PMID:26765233

  18. Anal Cancer: An Examination of Radiotherapy Strategies

    SciTech Connect

    Glynne-Jones, Rob; Lim, Faye

    2011-04-01

    The Radiation Therapy Oncology Group 9811, ACCORD-03, and ACT II Phase III trials in anal cancer showed no benefit for cisplatin-based induction and maintenance chemotherapy, or radiation dose-escalation >59 Gy. This review examines the efficacy and toxicity of chemoradiation (CRT) in anal cancer, and discusses potential alternative radiotherapy strategies. The evidence for the review was compiled from randomized and nonrandomized trials of radiation therapy and CRT. A total of 103 retrospective/observational studies, 4 Phase I/II studies, 16 Phase II prospective studies, 2 randomized Phase II studies, and 6 Phase III trials of radiotherapy or chemoradiation were identified. There are no meta-analyses based on individual patient data. A 'one-size-fits-all' approach for all stages of anal cancer is inappropriate. Early T1 tumors are probably currently overtreated, whereas T3/T4 lesions might merit escalation of treatment. Intensity-modulated radiotherapy or the integration of biological therapy may play a role in future.

  19. Anorectal conditions: anal fissure and anorectal fistula.

    PubMed

    Fox, Audralan; Tietze, Pamela H; Ramakrishnan, Kalyanakrishnan

    2014-04-01

    Anal fissures are linear splits in the anal mucosa. Acute fissures typically resolve within a few weeks; chronic fissures persist longer than 8 to 12 weeks. Most fissures are posterior and midline and are related to constipation or anal trauma. Painful defecation and rectal bleeding are common symptoms. The diagnosis typically is clinical. High-fiber diet, stool softeners, and medicated ointments relieve symptoms and speed healing of acute fissures but offer limited benefit in chronic fissures. Lateral internal sphincterotomy is the surgical management of choice for chronic and refractory acute fissures. Anorectal fistula is an abnormal tract connecting the anorectal mucosa to the exterior skin. Fistulas typically develop after rupture or drainage of a perianal abscess. Fistulas are classified as simple or complex; low or high; and intersphincteric, transsphincteric, suprasphincteric, or extrasphincteric. Inspection of the perianal area identifies the skin opening, and anoscopy visualizes internal openings. The goal of management is to obliterate the tract and openings with negligible sphincter disruption to minimize incontinence. Fistulotomy is effective for simple fistulas; patients with complex fistulas may require fistulectomy. Other procedures that are used include injection of fibrin glue or insertion of a bioprosthetic plug into the fistula opening. PMID:24742084

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

    PubMed Central

    Patel, Jigisha; Salit, Irving E; Berry, Michael J; de Pokomandy, Alexandra; 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. PMID:24740973

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

    PubMed

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

    2014-08-01

    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. PMID:24740973

  2. Anal squamous cell carcinoma: An evolution in disease and management

    PubMed Central

    Osborne, Marc C; Maykel, Justin; Johnson, Eric K; Steele, Scott R

    2014-01-01

    Anal cancer represents less than 1% of all new cancers diagnosed annually in the United States. Yet, despite the relative paucity of cases, the incidence of anal cancer has seen a steady about 2% rise each year over the last decade. As such, all healthcare providers need to be cognizant of the evaluation and treatment of anal squamous cell carcinoma. While chemoradiation remains the mainstay of therapy for most patients with anal cancer, surgery may still be required in recurrent, recalcitrant and palliative disease. In this manuscript, we will explore the diagnosis and management of squamous cell carcinoma of the anus. PMID:25278699

  3. Risk of Anal Cancer in People Living with HIV: Addressing Anal Health in the HIV Primary Care Setting.

    PubMed

    Walker, Crystal Martin; Likes, Wendy; Bernard, Marye; Kedia, Satish; Tolley, Elizabeth

    2016-01-01

    Anal health and anal cancer are rarely addressed in HIV primary care. We sought to understand factors that impeded or promoted addressing anal health in HIV primary care from providers' perspectives. In this exploratory study, HIV primary care providers from the Mid-South region of the United States participated in brief individual interviews. We analyzed transcribed data to identify barriers and facilitators to addressing anal health. Our study sample included five physicians and four nurse practitioners. The data revealed a number of barriers such as perception of patient embarrassment, provider embarrassment, external issues such as time constraints, demand of other priorities, lack of anal complaints, lack of resources, and gender discordance. Facilitators included awareness, advantageous circumstances, and the patient-provider relationship. Anal health education should be prioritized for HIV primary care providers. Preventive health visits should be considered to mitigate time constraints, demands for other priorities, and unequal gender opportunities. PMID:27080925

  4. Adenocarcinoma of the anal canal: A report of two cases with review of literature.

    PubMed

    Kulkarni, Medha Pradip; Momin, Yasmin Altaf; Pandav, Amitkumar Bapuso; Sulhyan, Kalpana Ranjitsingh

    2016-01-01

    Adenocarcinoma of the anal canal accounts for about 20% of all anal canal cancers. It is subclassified into two types. (1) Colorectal type, which arises from the mucosa above dentate line and (2) extramucosal type, which includes adenocarcinoma arising in anorectal fistulae and adenocarcinoma arising from anal glands. Anal gland adenocarcinomas are extremely rare. In this article, we present two cases of anal adenocarcinoma, one colorectal type, and other anal gland carcinoma along with review of literature. PMID:27510691

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

    PubMed Central

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

    2015-01-01

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

  6. [The anal incontinence-- study on 20 operated cases].

    PubMed

    Iusuf, T; Sârbu, V; Grasa, C; Cristache, C; Botea, F

    2001-01-01

    The authors present 20 cases operated for anal incontinence. Two techniques were performed: direct repair (18 cases) and Musset-Cottrell procedure (2 cases). The results were excellent in 12 cases, good in 5 cases and satisfactory in 3 cases. The method of choice seems to be the direct repair of the anal sphincter after a proper local and general preparation. PMID:12731180

  7. Anal cancer and intraepithelial neoplasia screening: A review

    PubMed Central

    Leeds, Ira L; Fang, Sandy H

    2016-01-01

    This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. A number of risk-stratification strategies as well as screening techniques have been suggested, and currently little consensus exists among national societies. Much of the current clinical rationale for the prevention of anal cancer derives from the similar tumor biology of cervical cancer and the successful use of routine screening to identify cervical cancer and its precursors early in the disease process. It is thought that such a strategy of identifying early anal intraepithelial neoplasia will reduce the incidence of invasive anal cancer. The low prevalence of anal cancer in the general population prevents the use of routine screening. However, routine screening of selected populations has been shown to be a more promising strategy. Potential screening modalities include digital anorectal exam, anal Papanicolaou testing, human papilloma virus co-testing, and high-resolution anoscopy. Additional research associating high-grade dysplasia treatment with anal cancer prevention as well as direct comparisons of screening regimens is necessary to develop further anal cancer screening recommendations. PMID:26843912

  8. Anal cancer and intraepithelial neoplasia screening: A review.

    PubMed

    Leeds, Ira L; Fang, Sandy H

    2016-01-27

    This review focuses on the early diagnosis of anal cancer and its precursor lesions through routine screening. A number of risk-stratification strategies as well as screening techniques have been suggested, and currently little consensus exists among national societies. Much of the current clinical rationale for the prevention of anal cancer derives from the similar tumor biology of cervical cancer and the successful use of routine screening to identify cervical cancer and its precursors early in the disease process. It is thought that such a strategy of identifying early anal intraepithelial neoplasia will reduce the incidence of invasive anal cancer. The low prevalence of anal cancer in the general population prevents the use of routine screening. However, routine screening of selected populations has been shown to be a more promising strategy. Potential screening modalities include digital anorectal exam, anal Papanicolaou testing, human papilloma virus co-testing, and high-resolution anoscopy. Additional research associating high-grade dysplasia treatment with anal cancer prevention as well as direct comparisons of screening regimens is necessary to develop further anal cancer screening recommendations. PMID:26843912

  9. Cost considerations in the treatment of anal fissures.

    PubMed

    Brisinda, Giuseppe; Bianco, Giuseppe; Silvestrini, Nicola; Maria, Giorgio

    2014-08-01

    Anal fissure is a split in the lining of the distal anal canal. Lateral internal sphincterotomy remains the gold standard for treatment of anal fissure. Although technique is simple and effective, a drawback of this surgical procedure is its potential to cause minor but some times permanent alteration in rectal continence. Conservative approaches (such as topical application of ointment or botulinum toxin injections) have been proposed in order to treat this condition without any risk of permanent injury of the internal anal sphincter. These treatments are effective in a large number of patients. Furthermore, with the ready availability of medical therapies to induce healing of anal fissure, the risk of a first-line surgical approach is difficult to justify. The conservative treatments have a lower cost than surgery. Moreover, evaluation of the actual costs of each therapeutic option is important especially in times of economic crisis and downsizing of health spending. PMID:24867398

  10. Research on a novel artificial anal sphincter for human incontinence.

    PubMed

    Zan, P; Yang, B; Zhang, J Y; Shao, Y

    2010-01-01

    This paper discusses a novel artificial anal sphincter with sensor feedback for controlling anal incontinence. The artificial anal sphincter system is a novel hydraulic-electric muscle which mainly comprises an artificial anal sphincter, a wireless power supply subsystem, and a communication subsystem. High integration of all functional components and no wire linking to the outer device make surgical implantation easier and lower risk. The wireless power supply subsystem employs a Class-E power amplifier based on adaptive control technique, and the electromagnetic compatibility in biological tissue is analysed. With the goal of designing a reliable and safe instrument, the models of human colonic blood flow and rectum motion are developed, the biomechanical material properties of human rectum and tissue ischaemia are analysed. The results show that the deformation of the artificial anal sphincter can be controlled by the press of reservoir below the upper limit of human tissue ischaemia. In vitro experiments demonstrate the artificial anal sphincter system is a good cure for human anal incontinence problems. PMID:20653341

  11. Ultrasound imaging of the anal sphincter complex: a review

    PubMed Central

    Abdool, Z; Sultan, A H; Thakar, R

    2012-01-01

    Endoanal ultrasound is now regarded as the gold standard for evaluating anal sphincter pathology in the investigation of anal incontinence. The advent of three-dimensional ultrasound has further improved our understanding of the two-dimensional technique. Endoanal ultrasound requires specialised equipment and its relative invasiveness has prompted clinicians to explore alternative imaging techniques. Transvaginal and transperineal ultrasound have been recently evaluated as alternative imaging modalities. However, the need for technique standardisation, validation and reporting is of paramount importance. We conducted a MEDLINE search (1950 to February 2010) and critically reviewed studies using the three imaging techniques in evaluating anal sphincter integrity. PMID:22374273

  12. Advances in the Management of Anal Cancer.

    PubMed

    Julie, Diana R; Goodman, Karyn A

    2016-03-01

    Although anal squamous cell carcinoma (ASCC) is an uncommon malignancy, its incidence has been increasing markedly in recent decades due to its association with human papilloma virus (HPV) infection. The well-established standard of care for localized ASCC consists of the combination of 5-fluorouracil (5FU) and mitomycin (MMC) chemotherapy, concurrent with external beam radiation therapy (EBRT). However, newer techniques are being actively pursued, including the use of newer radiation therapy (RT) technologies, such as intensity-modulated radiation therapy (IMRT). The areas of debate and development include the dosing and timing of MMC delivery, the role of cisplatin chemotherapy as an alternative to MMC, the replacement of the standard 96-h infusion of 5FU with oral capecitabine, the use of targeted chemotherapy agents, and the duration and dose of RT. PMID:26905274

  13. What Are the Risk Factors for Anal Cancer?

    MedlinePlus

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

  14. Anal Cancer Incidence and Mortality in Puerto Rico

    PubMed Central

    Colón-López, Vivian; Ortiz, Ana P.; Soto-Salgado, Marievelisse; Torres-Cintrón, Mariela; Mercado-Acosta, Juan José; Suárez, Erick

    2013-01-01

    Objective Anal cancer is a rare tumor that is associated with oncogenic HPV genotypes. This study aims to compare the age-standardized rates (ASRs) of anal cancer incidence and mortality in men and women living in Puerto Rico (PR) with those of non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Hispanics (USH) living in the continental United States (US). Methods ASRs were calculated based on cancer data that came from the PR Cancer Central Registry and from the Surveillance, Epidemiology, and End Results (SEER) program. The age-specific relative risks (RR) and 95% Confidence Interval (95% CI) were estimated using Poisson regression models. Results Comparing the period of 2001 to 2004 to that of 1992 to 1996, the incidence of anal cancer increased among NHW, NHB, and PR men. In females, an increase in the incidence was observed for all racial groups except for Puerto Rican women. When evaluating findings by age groups, Puerto Rican men younger than 60 years old had a 20% higher incidence of anal cancer than did USH men of the same age strata (RR: 2.20; 95% CI = 1.48–3.29). However, Puerto Rican females had a lower incidence of anal cancer than NHW and NHB women. An increased percent change in mortality was observed only in NHW and NHB men. A decreasing trend was observed in all racial/ethnic groups except for NHW women. Conclusion Our results support the notion that there are racial/ethnic differences in anal cancer incidence and mortality, with potential disparities among men and women in PR compared with USH men and women. Given the increasing incidence trends in anal cancer, particularly among PR, NHW, and NHB men, further investigation is needed to better elucidate screening practices that can aid in the prevention of anal cancer. PMID:23781623

  15. Current management of anal fistulas in Crohn's disease

    PubMed Central

    Eder, Piotr; Banasiewicz, Tomasz; Matysiak, Konrad; Łykowska-Szuber, Liliana

    2015-01-01

    Anal fistulas occurring in Crohn's disease (CD) comprise a risk factor of severe course of inflammation. They are frequently intractable due to various factors such as penetration of the anal canal or rectal wall, impaired wound healing, and immunosuppression, among others. Anal fistulas typical to CD develop from fissures or ulcers of the anal canal or rectum. Accurate identification of the type of fistula, such as low and simple or high and complex, is crucial for prognosis as well as for the choice of treatment. If fistulotomy remains the gold standard in the surgical treatment of the former, it is contraindicated in high and complex fistulas due to possible risk of damage to the anal sphincter with subsequent faecal incontinence. Therefore, the latter require a conservative and palliative approach, such as an incision and drainage of abscesses accompanying fistulas or prolonged non-cutting seton placement. Currently, conservative, sphincter-preserving, and definitive procedures such as mucosal advancement or dermal island flaps, the use of plugs or glue, video assisted anal fistula treatment, ligation of the intersphincteric track, and vacuum assisted closure are gaining a great deal of interest. Attempting to close the internal opening without injuring the sphincter is a major advantage of those methods. However, both the palliative and the definitive procedures require adjuvant therapy with medical measures. PMID:26557938

  16. A Rare Case of Granular Cell Tumor of the Anal Region: Diagnostic Difficulty to Masses in the Anal Area

    PubMed Central

    Fujii, Takaaki; Morita, Hiroki; Yamaguchi, Satoru; Tsutsumi, Soichi; Asao, Takayuki; Kuwano, Hiroyuki

    2014-01-01

    Granular cell tumor may be located anywhere in the body; however, the gastrointestinal tract is infrequently involved and anal granular cell tumors are extremely rare. We report herein a rare case of granular cell tumor in the anal region. In the current case, a 66-year-old Japanese woman was found to have a polypoid lesion in the anus with hemorrhoids. The mass detected as an anal polypoid lesion with ulceration was resected and diagnosed as granular cell tumor by histologic examination. Granular cell tumor of the anal region is rare, and benign perianal polypoid lesions are relatively uncommon clinical findings. They might present diagnostic challenges to surgeons and pathologists. Awareness of the differential diagnosis of granular cell tumor and careful microscopic examination might allow proper management and diagnosis. PMID:24444268

  17. A rare case of granular cell tumor of the anal region: diagnostic difficulty to masses in the anal area.

    PubMed

    Fujii, Takaaki; Morita, Hiroki; Yamaguchi, Satoru; Tsutsumi, Soichi; Asao, Takayuki; Kuwano, Hiroyuki

    2014-01-01

    Granular cell tumor may be located anywhere in the body; however, the gastrointestinal tract is infrequently involved and anal granular cell tumors are extremely rare. We report herein a rare case of granular cell tumor in the anal region. In the current case, a 66-year-old Japanese woman was found to have a polypoid lesion in the anus with hemorrhoids. The mass detected as an anal polypoid lesion with ulceration was resected and diagnosed as granular cell tumor by histologic examination. Granular cell tumor of the anal region is rare, and benign perianal polypoid lesions are relatively uncommon clinical findings. They might present diagnostic challenges to surgeons and pathologists. Awareness of the differential diagnosis of granular cell tumor and careful microscopic examination might allow proper management and diagnosis. PMID:24444268

  18. High prevalence of high grade anal intraepithelial neoplasia in HIV-infected women screened for anal cancer.

    PubMed

    Hou, June Y; Smotkin, David; Grossberg, Robert; Suhrland, Mark; Levine, Rebecca; Smith, Harriet O; Negassa, Abdissa; McAndrew, Thomas C; Einstein, Mark H

    2012-06-01

    There is no consensus on optimal screening for anal cancer (AC) in HIV+ women. Seven hundred fifteen unique asymptomatic women in a high-prevalence HIV+ community were screened for AC with anal cytology and triage to high-resolution anoscopy after routine screening was implemented in a large urban hospital system. Of these, 75 (10.5%) had an abnormal anal cytology and 29 (38.7%) of those with an abnormality had high-grade anal intraepithelial neoplasia (AIN). Women with poorly controlled HIV were significantly more likely to have high-grade AIN (P = 0.03). Given the high rate of AIN in screened HIV-infected women, routine AC screening in all HIV-infected women should be strongly considered. PMID:22466085

  19. Anal avulsion caused by abdominal crush injury.

    PubMed

    Terrosu, G; Rossetto, A; Kocjancic, E; Rossitti, P; Bresadola, V

    2011-12-01

    We report the case of a pelvic and lower abdomen crushing trauma in 37-year-old male patient. The patient had an open lumbar wound, laceration of the psoas muscle, pelvic fracture, a ruptured urogenital diaphragm, and extensive urogenital lacerations. An emergency laparotomy was performed with debridment, urethral reconstruction, and osteosynthesis of the pubic bone. The mobilization of the patient revealed a deep gap, about 8 × 8 cm, in the perineum, with the anus and rectum displaced from their original site. Anal reimplantation was performed, suturing the median raphe, inserting two pelvic drainage tubes, and fashioning a loop transverse colostomy. Closed rectal traumas account for only 4-11% of all rectal traumas. Crushing of the pelvis causes a sudden reduction in its anteroposterior diameter and a corresponding increase in its latero-lateral diameter, together with an abrupt rise in intra-abdominal pressure. The anus is pushed out of the perineal plane due to the divarication of the levator muscles. As suggested in the literature, the standard treatment is wound debridement with immediate or deferred repair, fashioning a diversion colostomy, and repair of the rectum, wherever possible. PMID:21556880

  20. HPV DNA prevalence and type distribution in anal carcinomas worldwide

    PubMed Central

    Alemany, L; Saunier, M; Alvarado, I; Quirós, B; Salmeron, J; Shin, HR; Pirog, E; Guimerà, N; Hernández, GA; Felix, A; Clavero, O; Lloveras, B; Kasamatsu, E; Goodman, MT; Hernandez, BY; Laco, J; Tinoco, L; Geraets, DT; Lynch, CF; Mandys, V; Poljak, M; Jach, R; Verge, J; Clavel, C; Ndiaye, C; Klaustermeier, J; Cubilla, A; Castellsagué, X; Bravo, IG; Pawlita, M; Quint, W; Muñoz, N; Bosch, FX; Sanjosé, S

    2014-01-01

    Knowledge about the human papillomaviruses (HPV) types in anal cancers in some world regions is scanty. Here we describe the HPV DNA prevalence and type distribution in a series of invasive anal cancers and anal intraepithelial neoplasias (AIN) grades 2/3 from 24 countries. We analyzed 43 AIN 2/3 cases and 496 anal cancers diagnosed from 1986 to 2011. After histopathological evaluation of formalin-fixed paraffin-embedded samples, HPV DNA detection and genotyping was performed using SPF-10/DEIA/LiPA25 system (version 1). A subset of 116 cancers was further tested for p16INK4a expression, a cellular surrogate marker for HPV-associated transformation. Prevalence ratios were estimated using multivariate Poisson regression with robust variance in cancer dataset. HPV DNA was detected in 88.3% of anal cancers (95%CI:85.1–91.0%) and in 95.4% of AIN 2/3 (95%CI:84.2–99.4%). Among cancers, the highest prevalence was observed in warty-basaloid subtype of squamous cell carcinomas, in younger patients and in North American geographical region. There were no statistically significant differences in prevalence by gender. HPV16 was the most frequent HPV type detected in both cancers (80.7%) and AIN 2/3 lesions (75.4%). HPV18 was the second most common type in invasive cancers (3.6%). p16INK4a overexpression was found in 95% of HPV DNA positive anal cancers. In view of HPV DNA results and high proportion of p16INK4a overexpression, infection by HPV is most likely to be a necessary cause for anal cancers in both men and women. The large contribution of HPV16 reinforces the potential impact of HPV vaccines in the prevention of these lesions. PMID:24817381

  1. Current treatment options for management of anal intraepithelial neoplasia.

    PubMed

    Weis, Stephen E

    2013-01-01

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

  2. Current treatment options for management of anal intraepithelial neoplasia

    PubMed Central

    Weis, Stephen E

    2013-01-01

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

  3. Treating anal fistula with the anal fistula plug: case series report of 12 patients

    PubMed Central

    Saba, Reza Bagherzadeh; Tizmaghz, Adnan; Ajeka, Somar; Karami, Mehdi

    2016-01-01

    Introduction Recurrent and complex high fistulas remain a surgical challenge. This paper reports our experience with the anal fistula plug in patients with complex fistulas. Methods Data were collected prospectively and analyzed from consecutive patients undergoing insertion of a fistula plug from January 2011 through April 2014 at Hazrat-e-Rasoul Hospital in Tehran. We ensured that sepsis had been eradicated in all patients prior to placement of the plug. During surgery, a conical shaped collagen plug was pulled through the fistula tract. Results Twelve patients were included in this case study. All patients had previously undergone failed surgical therapy to cure their fistula and had previously-placed Setons. There were eight males and four females with an average age of 44 who were treated for complex fistulas. At a median time of follow-up of 22.7 months, 10 of the 12 patients had healed (83.3%). One patient developed an abscess that was noted on the sixth postoperative day, and there was one recurrence during follow-up. Conclusions Fistula plugs are effective for the long-term closure of complex anal fistulas. Success of treatment with the fistula plug depends on the eradication of sepsis prior to plug placement. PMID:27280009

  4. Nicorandil associated anal ulcers: an estimate of incidence

    PubMed Central

    Colvin, HS; Barakat, T; Moussa, O; Babu, H; Slaughter, T; Palmer, JG; Hinson, FL

    2012-01-01

    INTRODUCTION Nicorandil is a commonly prescribed antianginal medication that has been found to be associated with painful anal ulceration. The incidence of this complication is unknown. We have used the best data available to us to make an estimate of this figure in a health district with a remarkably stable population of approximately 200,000 people. METHODS Using an electronic search of all letters generated from colorectal and gastroenterology clinics as well as endoscopy reports from January 2004 to November 2010, patients with anal ulceration who were taking nicorandil were identified. Other causes of ulceration were excluded by biopsy in the majority of cases. The central hospital and community pharmacy database was interrogated to estimate the number of patients who were prescribed nicorandil over a six-year period (2004-2010). RESULTS A total of 30 patients (24 men, 6 women) with a median age of 79.5 years were identified who fulfilled the criteria of: taking nicorandil; having no other identified cause for anal ulceration; and achieving eventual healing after withdrawal of nicorandil. In the six-year period an estimated mean of 1,379 patients were prescribed nicorandil each year. The mean annual incidence of anal ulcers among nicorandil users is therefore calculated to be in the region of 0.37%. CONCLUSIONS Anal ulceration appears to occur in approximately four in every thousand patients prescribed nicorandil each year. Prescribing physicians should explain the risk of this unpleasant complication to their patients. PMID:22507720

  5. Metachronous tubulovillous and tubular adenomas of the anal canal.

    PubMed

    Nozawa, Hiroaki; Ishihara, Soichiro; Morikawa, Teppei; Tanaka, Junichiro; Yasuda, Koji; Ohtani, Kensuke; Nishikawa, Takeshi; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Kawai, Kazushige; Hata, Keisuke; Kazama, Shinsuke; Yamaguchi, Hironori; Sunami, Eiji; Kitayama, Joji; Fukayama, Masashi; Watanabe, Toshiaki

    2015-01-01

    Anal canal adenoma is an extremely rare disease that has the potential to transform into a malignant tumor. We herein presented a rare case of metachronous multiple adenomas of the anal canal. A 48-year-old woman underwent total colonoscopy following a positive fecal blood test. A 9-mm villous polyp arising from the posterior wall of the anal canal was removed by snare polypectomy. Histologically, the tumor was tubulovillous adenoma with high-grade dysplasia and the cut end was negative for tumor cells. Six years later, an elevated lesion, macroscopically five millimeters in size, was detected in the left wall of the anal canal in a follow-up colonoscopy. Local excision of the tumor was performed, and the lesion was pathologically confirmed to be tubular adenoma with high-grade dysplasia limited to the mucosa. The patient is currently alive without any evidence of recurrence for six months after surgery. Although she had a past history of cervical cancer, the multiple tumors arising in the anal canal were unlikely to be related to human papilloma virus infection. Our case report underscores the importance of careful observations throughout colonoscopy to detect precancerous lesions, particularly in anatomically narrow segments. PMID:26249723

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

    Cancer.gov

    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

  7. Anal encirclement with polypropylene mesh for rectal prolapse and incontinence.

    PubMed

    Sainio, A P; Halme, L E; Husa, A I

    1991-10-01

    Seventeen selected patients (mean age, 74 years)--14 with rectal prolapse and 3 with persisting anal incontinence after previous operations--underwent high anal encirclement with polypropylene mesh. There was no operative mortality. Prolapse recurred in 2 (15 percent) of the 13 patients followed up for 6 months or more (mean, 3.5 years). Three (27 percent) of the 11 patients with associated anal incontinence improved functionally, as did the three operated on for persisting incontinence, but only one patient regained normal continence. No breakage, cutting out, or infection related to the mesh was observed. Because of the risk of fecal impaction encountered in three of our patients, the procedure is not advocated for severely constipated patients. Despite the somewhat disappointing results regarding restoration of continence, we find this method useful in patients with rectal prolapse who are unfit for more extensive surgery, in controlling the prolapse to an acceptable degree. PMID:1914725

  8. Disseminated neonatal herpetic infection simulating abusive anal trauma.

    PubMed

    Panella, Michael

    2011-07-01

    Potential simulators of premortem trauma present problems of misinterpretation and possible false accusations of caregivers. A case of unsuspected neonatal herpes is reported with associated perianal ecchymosis that raises the possibility of sexual abuse. The decedent was an 8-day-old newborn infant who was born by Cesarean section and treated for 5 days postdelivery for sepsis. The newborn infant was discharged home but returned 2 days later with probable sepsis and new onset of perianal hemorrhage. She died 1 day later with autopsy, revealing neonatal disseminated herpetic infection with early anal involvement consisting of microscopic ulcerations with leukocytoclastic-like vasculitis and rare viral cytopathic changes. These histological changes produced grossly appearing anal ecchymosis with an absence of typical herpetic vesiculopapular lesions, which simulated abusive trauma. This case highlights the importance of considering occult neonatal herpes with associated perianal ecchymosis when presented with possible abusive anal trauma in a newborn infant. PMID:21496019

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

    PubMed

    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? PMID:24139082

  10. Anal Cancer debuting as Cancer of Unknown Primary

    PubMed Central

    Sveistrup, Joen; Loft, Annika; Engelholm, Svend Aage

    2011-01-01

    Anal cancer usually presents with a visible or palpable tumour. In this case we describe a 54-year old man diagnosed with Cancer of Unknown Primary (CUP) with a single inguinal node as the only finding. Thorough examination failed to identify any primary tumour. The patient was treated with lymph node dissection and not until nearly two years after initial diagnosis, was the primary tumour found, and the patient was diagnosed with anal cancer. The patient was treated with chemoradiotherapy and 45 months after initial diagnosis there is still no sign of relapse. This case illustrates, that anal cancer can metastasise before the primary tumour is detectable. Furthermore, it demonstrates the necessity of thorough clinical follow-up after treatment of CUP since the primary tumour was found later. Finally this is a case of a long-term survivor following treatment for metastatic inguinal lymph nodes from an initially unknown primary cancer. PMID:21769317

  11. Anal Cancer Screening Behaviors and Intentions in Men Who Have Sex with Men

    PubMed Central

    Cook, Robert L.; Ostrow, David; Johnson-Hill, Lisette M.; Wiley, Dorothy; Silvestre, Tony

    2008-01-01

    ABSTRACT Background The incidence of anal cancer has increased in the past decade, especially among men who have sex with men (MSM) and HIV-infected individuals. There is controversy about whether to routinely screen for anal cancer in MSM. Objectives To determine whether current anal cancer screening behaviors, intention, and concern differ by HIV serostatus and to identify characteristics of men who intend to seek anal cancer screening. Design and Participants Cross-sectional analysis of data collected from 901 HIV-infected and 1,016 HIV-uninfected MSM from the Multicenter AIDS Cohort Study (MACS) in 2005–2006. Measurements Self-reported anal cancer screening history, attitudes, and intentions. Results A history of anal warts was relatively common in these men (39%), whereas having a recent anal Pap test (5%), intention to seek anal cancer screening in the next 6 months (12%), and concern about anal cancer (8.5%) were less common. Intention to seek anal cancer screening was associated with enabling factors (screening availability, health insurance), need factors (HIV-infection, history of anal warts), concern about anal cancer, and recent sexual risk taking. Among four large US cities, there was significant regional variability in anal cancer screening behaviors, intention, and concern (all p<0.001). Most MSM (76%) indicated they would go to their primary care physician for an anal health problem or question. Conclusions This study demonstrates a low rate of anal cancer screening and intention to screen among MSM. As more evidence emerges regarding screening, primary care physicians should be prepared to discuss anal cancer screening with their patients. PMID:18618198

  12. Epidermal growth factor receptor inhibition in metastatic anal cancer.

    PubMed

    Rogers, Jane E; Ohinata, Aki; Silva, Ninoska N; Mehdizadeh, Amir; Eng, Cathy

    2016-09-01

    Metastatic squamous cell carcinoma (SCCA) anal cancer is relatively rare. With limited data, cisplatin plus 5-fluorouracil has traditionally been utilized in the first-line setting. Treatment beyond front-line cisplatin progression is not well defined. Epidermal growth factor receptor (EGFR) is highly overexpressed in SCCA anal cancer and EGFR inhibition may represent a potential treatment target for this population in need. Our case series evaluated metastatic SCCA anal cancer patients who received an EGFR monoclonal antibody as second-line or third-line therapy. Data collected consisted of demographics, previous treatment, metastatic disease sites, localized therapy received, regimen received, first radiographic result, progression-free survival, and overall survival. A total of 17 patients were included, with most (76%) patients receiving an EGFR monoclonal antibody in the second-line setting. Common regimens identified combined cetuximab or panitumumab with a fluoropyrimidine plus platinum (35%), carboplatin plus paclitaxel (29%), or cisplatin plus vinorelbine (18%). Thirty-five percent of patients achieved a response and 24% had stable disease. The overall median progression-free survival and overall survival were 7.3 and 24.7 months, respectively. Compared with our large retrospective study in the front-line metastatic anal cancer setting, our study suggests that anti-EGFR therapy in combination with certain chemotherapy derived additional benefit in the refractory setting. In the metastatic setting, there is a need to discover effective therapies. We present a diverse metastatic SCCA anal cancer patient population who received cetuximab or panitumumab with chemotherapy in the second-line or third-line setting. Our case series strengthens the concept of EGFR inhibition in metastatic SCCA anal cancer. PMID:27272412

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

    PubMed Central

    Gandra, Sumanth; Azar, Aline; Wessolossky, Mireya

    2015-01-01

    Background 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. PMID:25670914

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

    PubMed Central

    2011-01-01

    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. PMID:21838873

  15. Anal lesions presenting in a cohort of child gastroenterological examinations. Implications for sexual traumatic injuries.

    PubMed

    Rougé-Maillart, Clotilde; Houdu, Sora; Darviot, Estelle; Buchaillet, Céline; Baron, Céline

    2015-05-01

    The purpose of this study was to describe the anal lesions found in children during a pediatric gastroenterology consultation when the reason for the complaint was related to a digestive disease. This prospective descriptive study included 100 children under 15 years of age over a 13-month period, consulting due to digestive symptoms. The children were under 8 years old (90%) and 25% were under 3.1 years old. Constipation was the most frequent reason for consultation (69%). Fifty-one anal lesions were observed, of which 58.8% were anal fissures, 15.7% were skin tags and 5.8% were venous congestions related to straining. Anal fissures and skin tags were located at the median line, according to the clock-face method in supine position. No child had more than two anal lesions. No anal dilatation, sphincter hypotonia, anal scars, anal lacerations or bruises were found. The two most common anal lesions were anal fissures and skin tags. These anal lesions were mainly observed at the median line and were due to constipation. No cases of multiple anal lesions were found in terms of common digestive diseases. PMID:25882145

  16. Anatomical Disruption & Length-Tension Dysfunction of Anal Sphincter Complex Muscles in Women with Fecal Incontinence

    PubMed Central

    Kim, Young Sun; Weinstein, Milena; Raizada, Varuna; Jiang, Yanfen; Bhargava, Valmik; Rajasekaran, M. Raj; Mittal, Ravinder K.

    2013-01-01

    BACKGROUND Anal sphincter complex muscles; internal anal sphincter, external anal sphincter and puborectalis muscles, play important role in the anal continence mechanism. Patients with symptoms of fecal incontinence have weak anal sphincter complex muscles; however, their length-tension properties and relationship to anatomical disruption have never been studied. OBJECTIVE To assess the anatomy of anal sphincter complex muscles using 3D-ultrasound imaging system and determine the relationship between anatomical defects and length-tension property of external anal sphincter and puborectalis muscles in women with incontinence symptoms and control subjects. DESIGN Severity of anal sphincter muscle damage was determined by static and dynamic 3Dimensional-ultrasound imaging. Length-tension property was determined by anal and vaginal pressure respectively using custom designed probes. PATIENTS 44 asymptomatic controls and 24 incontinent patients participated in this study. MAIN OUTCOME MEAUSURES Anatomical defects and length-tension dysfunction of anal sphincter complex muscles in FI patients were evaluated. RESULT Prevalence of injury to sphincter muscles are significantly higher in the incontinent patients compared to controls. 85% of patients but only 9% controls reveal damage to ≥2 of the 3 muscles of anal sphincter complex. Anal and vaginal squeeze pressure increased with increase in the probe size (length-tension curve) in majority of controls. In patients, the increase in anal and vaginal squeeze pressures was either significantly smaller than controls or it decreased with the increasing probe size (abnormal length-tension). CONCLUSIONS Length-tension property of the external anal sphincter and puborectalis muscles is significantly impaired in incontinent patients. Our findings have therapeutic implication in the treatment of anal incontinence. PMID:24105004

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

    PubMed

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

    2014-01-01

    A non-healing peri-anal abscess can be difficult to manage and is often attributed to chronic disease. This case documents a male in his seventh decade who presented with multiple peri-anal collections. The abscess cavity had caused necrosis of the internal sphincter muscles resulting in faecal incontinence. Biopsies were conclusive for diffuse large B-cell lymphoma. A de-functioning colostomy was performed and the patient was initiated on CHOP-R chemotherapy. Anal lymphoma masquerading as a peri-anal abscess is rare. A high degree of suspicion must be maintained for an anal abscess which does not resolve with conservative management. PMID:24898408

  18. Carcinoma of the anal canal and flow cytometric DNA analysis.

    PubMed Central

    Scott, N. A.; Beart, R. W.; Weiland, L. H.; Cha, S. S.; Lieber, M. M.

    1989-01-01

    Using flow cytometric DNA analysis of paraffin embedded tissue, DNA histograms were successfully obtained from the anal cancers of 117 patients. DNA diploid patterns were given by 82 cancers (70%) and DNA non-diploid patterns by 35 cancers (30%): 15 DNA aneuploid, 20 DNA tetraploid. Well differentiated squamous cell cancers were mainly DNA diploid, while a larger proportion of poorly differentiated and small cell cancers were DNA non-diploid. The large majority of stage A cancers were DNA diploid. A greater proportion of tumours that had invaded through the anal sphincter or had lymph node metastases or distant spread were DNA non-diploid. Prognosis was slightly poorer for patients with DNA non-diploid cancers when compared to patients with DNA diploid tumours (P = 0.08) and significantly poorer for individuals with DNA aneuploid anal cancers (P = 0.037). However, in a multivariate analysis model, the DNA ploidy pattern of an anal cancer was not of independent prognostic significance alongside tumour histology and tumour stage. PMID:2803916

  19. Primary radiation therapy in the treatment of anal carcinoma

    SciTech Connect

    Cantril, S.T.; 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.

  20. Histo-topographic study of the longitudinal anal muscle.

    PubMed

    Macchi, Veronica; Porzionato, Andrea; Stecco, Carla; Vigato, Enrico; Parenti, Anna; De Caro, Raffaele

    2008-07-01

    The longitudinal anal muscle (LAM) has been described as a vertical layer of muscular tissue interposed between the circular layers of the internal (IAS) and external (EAS) anal sphincters. There is, however, no general agreement in the literature on its composition and attachments. The aim of this study was to investigate the histological structure, attachments, and topography of the LAM in order to evaluate its role in continence and defecation, thus enhancing knowledge of the surgical anatomy of this region. After in situ formalin fixation, the pelvic viscera were removed from eight male and eight female cadavers (age range: 52-72 years). Serial macrosections of the bladder base, lower rectum and anal canal, cervix and pelvic floor complex, cut in the transverse (six specimens) and coronal (six specimens) planes, underwent histological and immunohistochemical studies. Four specimens were studied using the E12 sheet plastination technique. The LAM was identified in 10/12 specimens (83%). Transverse and coronal sections made clear that it is a longitudinal layer of muscular tissue, marking the boundary between the internal and external anal sphincters. From the anorectal junction it extends along the anal canal, receives fibers from the innermost part of the puborectalis and the puboanalis muscles, and terminates with seven to nine fibro-elastic septa, which traverse the subcutaneous part of the external anal sphincter, reaching the perianal dermis. In the transverse plane, the mean thickness of the LAM was 1.68 +/- 0.27 mm. Immunohistochemical staining showed that the LAM consists of predominantly outer striated muscle fibers and smaller numbers of inner smooth muscle fibers, respectively coming from the levator ani muscle and from the longitudinal muscular layer of the rectum. The oblique fibers suggest that the LAM may represent the intermediate longitudinal course of small bridging muscle bundles going reciprocally from the striated EAS to the smooth IAS and

  1. Human papillomavirus, anal cancer, and screening considerations among HIV-infected individuals.

    PubMed

    Cachay, Edward R; Mathews, William Christopher

    2013-01-01

    Invasive anal cancer has become an important cause of non AIDS-related cancer among HIV-infected individuals. Human papillomavirus is the main etiological agent. This review explains the pathophysiologic role of human papillomavirus in the development of invasive anal cancer, summarizes recent epidemiological trends of invasive anal cancer, and reviews the evidence to address common clinical questions posed when screening for anal cancer in HIV-infected patients. The effect of highly active antiretroviral therapy on human papillomavirus oncogenesis is still unclear, but given the increased clinical burden of invasive anal cancer among HIV-infected patients, many clinics have implemented screening programs for anal cancer and its precursors. Despite the availability of several modalities for treatment of precursors of anal cancer, evidence that current treatment modalities favorably alter the natural history of human papillomavirus oncogenesis in the anal and perianal regions is still inconclusive. However, there is sufficient evidence to state that the accuracy of anal cancer screening procedures (cytology and high-resolution anoscopy directed biopsy) is comparable to the accuracy of those used in screening for cervical cancer precursors. Studies that systematically assess the efficacy of these anal cancer screening programs in reducing the incidence of and morbidity and mortality from invasive anal cancer among HIV-infected patients are needed. PMID:23681437

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

    PubMed

    do Socorro Nobre, Maria; Jacyntho, Claudia Marcia; Eleutério, José; Giraldo, Paulo César; Gonçalves, Ana Katherine

    2016-01-01

    The purpose of this study was to assess the risk of abnormal anal cytology in women with known genital squamous intraepithelial lesion. This study evaluated 200 women with and without genital squamous intraepithelial lesion who were recruited for anal Pap smears. Women who had abnormal results on equally or over atypical squamous cells of undetermined significance were classified as having abnormal anal cytology. A multiple logistic regression analysis (stepwise) was performed to identify the risk for developing abnormal anal cytology. Data were analyzed using the SPSS 20.0 program. The average age was 41.09 (±12.64). Of the total participants, 75.5% did not practice anal sex, 91% did not have HPV-infected partners, 92% did not have any anal pathology, and 68.5% did not have anal bleeding. More than half (57.5%) had genital SIL and a significant number developed abnormal anal cytology: 13% in the total sample and 17.4% in women with genital SIL. A significant association was observed between genital squamous intraepithelial lesion and anal squamous intraepithelial lesion (PR=2.46; p=0.03). In the logistic regression model, women having genital intraepithelial lesion were more likely to have abnormal anal Pap smear (aPR=2.81; p=0.02). This report shows that women with genital squamous intraepithelial lesion must be more closely screened for anal cancer. PMID:27037113

  3. Incidence and Predictors of Anal Incontinence after Obstetric Anal Sphincter Injury in Primiparous Women

    PubMed Central

    Richter, Holly E; Nager, Charles W; Burgio, Kathryn L; Whitworth, Ryan; Weidner, Alison C; Schaffer, Joseph; Zyczynski, Halina M; Norton, Peggy; Jelovsek, J Eric; Meikle, Susan F; Spino, Cathie; Gantz, Marie; Graziano, Scott; Brubaker, Linda

    2014-01-01

    Objective To describe the incidence of fecal incontinence (FI) at 6, 12 and 24 weeks postpartum, anal incontinence (AI) and fecal urgency at 24 weeks and identify predictors of AI in women with obstetric anal sphincter injury (OASI). Methods Primiparous women sustaining OASIs were identified at 8 clinical sites. Third degree OASIs were characterized using World Health Organization (WHO) criteria, 3a (<50%) or 3b (>50%) tear through the sphincter. FI was defined as leakage of liquid/solid stool and/or mucus in the past month; AI was defined as leakage of liquid/solid stool and/or mucus and/or gas in the past month and was assessed at 6, 12 and 24 weeks postpartum using the Fecal Incontinence Severity Index. Logistic regression identified variables associated with AI. Results 343 women participated: 297 subjects sustained a third degree OASI, 168 type 3a, 98 type 3b and 31 indeterminant; 45 had a fourth degree OASI. Overall FI incidence at 6, 12 and 24 weeks was 7% (23/326, 95% CI: 4%,10%), 4% (6/145, 95% CI: 2%,9%) and 9% (13/138, 95% CI: 5%,16%), respectively. At 24 weeks AI incidence was 24% (95% CI: 17%,32%) and fecal urgency 21% (95% CI: 15%,29%). No significant differences in FI and AI rates were noted by 3rd degree type or between groups with 3rd and 4th OASI. Flatal incontinence was greater in women sustaining a 4th degree tear (35% vs 16%, p=0.04). Caucasian race (AOR 4.64, 95% CI: 1.35-16.02) and shorter duration of second stage (AOR 1.47 per 30 minute decrease, 95% CI: 1.12-1.92) were associated with AI at 24 weeks. Conclusions Overall 24-week incidence of FI is 9% (95% CI: 5%,16%) and AI is 24% (95% CI: 17%,32%). In women with OASI, Caucasian race and shorter second stage labor were associated with postpartum AI. PMID:25679358

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

    SciTech Connect

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

    1992-08-01

    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.

  5. Tumors and Tumorlike Conditions of the Anal Canal and Perianal Region: MR Imaging Findings.

    PubMed

    Surabhi, Venkateswar R; Menias, Christine O; Amer, Ahmed M; Elshikh, Mohamed; Katabathina, Venkata S; Hara, Amy K; Baughman, William C; Kielar, Ania; Elsayes, Khaled M; Siegel, Cary L

    2016-01-01

    Tumors and tumorlike conditions of the anus and perianal region originate from the anal canal and anal margin or result from direct extension of tumors from adjacent organs. The anatomy of the anal canal is complex, and its different histologic characteristics can lead to diverse pathologic conditions. The anal canal extends from the anorectal junction to the anal verge. The World Health Organization classification of anal canal tumors includes (a) anal intraepithelial neoplasia, the precursor of squamous cell carcinoma (SCC), and (b) invasive tumors. Invasive tumors are further classified on the basis of cell type as epithelial tumors (SCC, adenocarcinoma, mucinous adenocarcinoma, small cell carcinoma, and undifferentiated carcinoma), nonepithelial tumors, carcinoid tumors, melanoma, and secondary tumors (direct spread from rectal, cervical, or prostate carcinoma). The anal margin, or perianal skin, lies outside the anal verge and encompasses a radius of 5 cm from the anal verge. Tumors in the anal margin are classified according to the World Health Organization classification of skin tumors. Anal margin tumors include SCC, anal intraepithelial neoplasia, also known as Bowen disease, adenocarcinoma and its precursor Paget disease, basal cell carcinoma, and verrucous carcinoma (Buschke-Löwenstein tumor), which is a rare variant of SCC. Imaging plays an important role in the evaluation, staging, and follow-up of patients with anal and perianal tumors. However, because of the overlap in imaging features among these diverse entities, a definitive diagnosis is best established at histopathologic examination. Nevertheless, familiarity with the pathogenesis, imaging features, and treatment of these tumors can aid radiologic diagnosis and guide appropriate patient treatment. (©)RSNA, 2016. PMID:27618320

  6. Increased HIV-1 activity in anal high-grade squamous intraepithelial lesions compared with unaffected anal mucosa in men who have sex with men.

    PubMed

    Pollakis, Georgios; Richel, Olivier; Vis, Joost D; Prins, Jan M; Paxton, William A; de Vries, Henry J C

    2014-06-01

    We studied 3 patients with focal intra-anal tissue high-grade squamous intraepithelial lesions (HSILs). All had increased human immunodeficiency virus type 1 (HIV-1) RNA and DNA in lesions compared with that in healthy mucosa. HIV-1 RNA and HIV-1 episomal DNA were indicative of ongoing viral replication, more so in anal HSILs. PMID:24604897

  7. Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid-, and distal levels.

    PubMed

    Hall, Rebecca J; Rogers, Rebecca G; Saiz, Lori; Qualls, C

    2007-08-01

    The purpose of this study was to measure the internal and external anal sphincters using translabial ultrasound (TLU) at the proximal, mid, and distal levels of the anal sphincter complex. The human review committee approval was obtained and all women gave written informed consent. Sixty women presenting for gynecologic ultrasound for symptoms other than pelvic organ prolapse or urinary or anal incontinence underwent TLU. Thirty-six (60%) were asymptomatic and intact, 13 symptomatic and intact, and 11 disrupted. Anterior-posterior diameters of the internal anal sphincter at all levels and the external anal sphincter at the distal level were measured in four quadrants. Mean sphincter measurements are given for symptomatic and asymptomatic intact women and are comparable to previously reported endoanal MRI and ultrasound measurements. PMID:17221149

  8. Anal cancer treatment: Current status and future perspectives

    PubMed Central

    Ghosn, Marwan; Kourie, Hampig Raphael; Abdayem, Pamela; Antoun, Joelle; Nasr, Dolly

    2015-01-01

    Anal cancers (AC) are relatively rare tumors. Their incidence is increasing, particularly among men who have sex with other men due to widespread infection by human papilloma virus. The majority of anal cancers are squamous cell carcinomas, and they are treated according to stage. In local and locally advanced AC, concomitant chemoradiation therapy based on mitomycin C and 5-Fluorouracil (5-FU) is the current best treatment, while metastatic AC, chemotherapy with 5-FU and cisplatin remains the gold standard. There are no indications for induction or maintenance therapies in locally advanced tumors. Many novel strategies, such as targeted therapies, vaccination, immunotherapy and photodynamic therapy are in clinical trials for the treatment of AC, with promising results in some indications. PMID:25741135

  9. A Very Rare Cause of Anal Atresia: Currarino Syndrome

    PubMed Central

    Buyukbese Sarsu, Sevgi; Parmaksiz, Mehmet Ergun; Cabalar, Esra; Karapur, Ali; Kaya, Cihat

    2016-01-01

    Currarino syndrome (triad) is an extremely rare condition characterized by presacral mass, anorectal malformation, and sacral bone deformation. The complete form of this syndrome displays all three irregularities. Herein, we report a male case who was admitted to our hospital with symptoms of urinary system infection and persistent constipation 2 years after colostomy operation performed with the indication of rectovestibular fistula and anal atresia, diagnosed as Currarino syndrome based on imaging modalities. In a patient who was admitted because of the presence of anal atresia, in order to preclude potential complications, probable concomitancy of this syndrome should not be forgotten. Early diagnosis is important for the prevention of meningitis, urinary tract infections, and malignant change. PMID:27081429

  10. Challenges faced in the clinical application of artificial anal sphincters*

    PubMed Central

    Wang, Ming-hui; Zhou, Ying; Zhao, Shuang; Luo, Yun

    2015-01-01

    Fecal incontinence is an unresolved problem, which has a serious effect on patients, both physically and psychologically. For patients with severe symptoms, treatment with an artificial anal sphincter could be a potential option to restore continence. Currently, the Acticon Neosphincter is the only device certified by the US Food and Drug Administration. In this paper, the clinical safety and efficacy of the Acticon Neosphincter are evaluated and discussed. Furthermore, some other key studies on artificial anal sphincters are presented and summarized. In particular, this paper highlights that the crucial problem in this technology is to maintain long-term biomechanical compatibility between implants and surrounding tissues. Compatibility is affected by changes in both the morphology and mechanical properties of the tissues surrounding the implants. A new approach for enhancing the long-term biomechanical compatibility of implantable artificial sphincters is proposed based on the use of smart materials. PMID:26365115

  11. A Very Rare Cause of Anal Atresia: Currarino Syndrome.

    PubMed

    Buyukbese Sarsu, Sevgi; Parmaksiz, Mehmet Ergun; Cabalar, Esra; Karapur, Ali; Kaya, Cihat

    2016-05-01

    Currarino syndrome (triad) is an extremely rare condition characterized by presacral mass, anorectal malformation, and sacral bone deformation. The complete form of this syndrome displays all three irregularities. Herein, we report a male case who was admitted to our hospital with symptoms of urinary system infection and persistent constipation 2 years after colostomy operation performed with the indication of rectovestibular fistula and anal atresia, diagnosed as Currarino syndrome based on imaging modalities. In a patient who was admitted because of the presence of anal atresia, in order to preclude potential complications, probable concomitancy of this syndrome should not be forgotten. Early diagnosis is important for the prevention of meningitis, urinary tract infections, and malignant change. PMID:27081429

  12. Dietary habits after ileal pouch-anal anastomosis.

    PubMed

    Chartrand-Lefebvre, C; Heppell, J; Davignon, I; Dubé, S; Pomp, A

    1990-04-01

    Dietary habits of patients who had undergone ileal pouch-anal anastomosis were assessed and correlated with bowel function. Twenty-four well-adapted patients (11 women, 13 men; mean age 32 years) voluntarily entered the study 30 +/- 4 months after closure of the diverting ileostomy. A standardized questionnaire on 108 food items and a 3-day food journal were used in the assessment. Twenty-one patients had no difficulty in selecting an appropriate diet. Caloric intake was adequate. Specific symptoms associated with several foods were as follows: increased stool frequency (beer, spirits, chinese food), decreased stool consistency (beer, wine, fried fish), perianal irritation (spicy foods), undigested particles (grapefruit, lettuce), odours (eggs). Pasta and bananas were associated with increased stool consistency. The authors believe that these observations may help in dietary counselling after ileal pouch-anal anastomosis. PMID:2268807

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

    PubMed

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

    2014-03-01

    The incidence of anal cancer is elevated in human immunodeficiency virus (HIV)-infected men-who-have-sex-with-men (MSM) compared to the general population. Anal high-grade squamous intraepithelial lesions (HSIL) are common in HIV-infected MSM and the presumed precursors to anal squamous cell cancer; however, direct progression of HSIL to anal cancer has not been previously demonstrated. The medical records were reviewed of 138 HIV-infected MSM followed up at the University of California, San Francisco, who developed anal canal or perianal squamous cancer between 1997 and 2011. Men were followed up regularly with digital anorectal examination (DARE), high-resolution anoscopy (HRA) and HRA-guided biopsy. Although treatment for HSIL and follow-up were recommended, not all were treated and some were lost to follow-up. Prevalent cancer was found in 66 men. Seventy-two HIV-infected MSM developed anal cancer while under observation. In 27 men, anal cancer developed at a previously biopsied site of HSIL. An additional 45 men were not analyzed in this analysis due to inadequate documentation of HSIL in relation to cancer location. Of the 27 men with documented progression to cancer at the site of biopsy-proven HSIL, 20 men progressed from prevalent HSIL identified when first examined and seven men from incident HSIL. Prevalent HSIL progressed to cancer over an average of 57 months compared to 64 months for incident HSIL. Most men were asymptomatic, and cancers were detected by DARE. Anal HSIL has clear potential to progress to anal cancer in HIV-infected MSM. Early diagnosis is facilitated by careful follow-up. Carefully controlled studies evaluating efficacy of screening for and treatment of HSIL to prevent anal cancer are needed. PMID:23934991

  14. Management of obstetric anal sphincter injuries (OASIS) in subsequent pregnancy.

    PubMed

    Evans, C; Archer, R; Forrest, A; Barrington, J

    2014-08-01

    Obstetric anal sphincter injuries (OASIS) are common and may greatly affect a patient's quality of life. There is very little information regarding optimum management in future pregnancies. Based upon anecdotal experience, this study describes the recommendations of a cohort of consultant obstetricians in the UK, in this clinical situation. There is limited adherence to the available national guidelines due to the absence of available equipment and expertise to perform endo-anal ultrasound and manometry. Elective episiotomy is still recommended by a small number of obstetricians but the majority of patients are routinely followed-up. Caesarean section is only advised for asymptomatic patients with a previous stage 4 tear, and for any symptomatic patient with a previous stage 3 or 4 tear, irrespective of subgrade. A request for elective caesarean section is likely to be granted, irrespective of OASIS grade. The use of postpartum endo-anal ultrasound would help identify those women in whom a further vaginal delivery is unlikely to exacerbate any symptoms of faecal incontinence. PMID:24800795

  15. Thermal responses of shape memory alloy artificial anal sphincters

    NASA Astrophysics Data System (ADS)

    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.

  16. Hemorrhoids and anal fissures in inflammatory bowel disease.

    PubMed

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

    2015-12-01

    Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis. PMID:26446683

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

    PubMed

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

    2016-03-01

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

  18. Anal intraepithelial neoplasia--is treatment better than observation?

    PubMed

    Orchard, M; Roman, A; Parvaiz, A C

    2013-01-01

    Anal Intraepithelial Neoplasia (AIN) is an increasingly common condition for which the best treatment has not been well established. Traditional management was based on a 'watch and wait' strategy, but as the natural history of AIN and its progression to anal cancer is becoming better understood, more active treatment strategies are warranted. A best evidence topic in surgery was written according to a structured protocol to address the question whether treatment is indicated in patients with AIN. A total of 169 papers were identified using the defined search criteria. This included only one randomised controlled trial. Case series were therefore also included to help answer the question. The details of the papers were tabulated including relevant outcomes and study weaknesses. We conclude that treatment of high grade AIN, particularly in high risk groups is recommended to try to avoid progression to anal cancer. Treatment options that have shown some benefit include topical use of imiquimod cream or ablation directed by high resolution anoscopy. PMID:23643642

  19. Obstetrics anal sphincter injury and repair technique: a review.

    PubMed

    Temtanakitpaisan, Teerayut; Bunyacejchevin, Suvit; Koyama, Masayasu

    2015-03-01

    The Urogynecology Committee of the Asia and Oceania Federation of Obstetrics and Gynaecology (AOFOG) has held seminars and workshops on various urogynecological problems in each country in the Asia-Oceania area in order to encourage young obstetricians and gynecologists. In 2013, we organized the operative seminar for obstetrical anal sphincter injuries (OASIS) in which we prepared porcine models to educate young physicians in a hands-on workshop at the 23rd Asian and Oceanic Congress of Obstetrics and Gynaecology in Bangkok, Thailand. Laceration of the anal sphincter mostly occurs during vaginal delivery and it can develop into anal sphincter deficiency, which causes fecal incontinence, if an appropriate suture is not performed. OASIS has become an important issue, especially in developing countries. The prevalence of OASIS of more than the third degree is around 5% in primary parous women and the frequency is higher when detected by ultrasonographic evaluation. Several risk factors, such as macrosomia, instrumental labor, perineal episiotomy and high maternal age, have been recognized. In a society where pregnant women are getting older, OASIS is becoming a more serious issue. An intrapartum primary appropriate stitch is important, but the 1-year outcome of a delayed operation after 2 weeks postpartum is similar. A randomized controlled study showed that overlapping suture of the external sphincter is better than that of end-to-end surgical repair. The Urogynecology Committee of the AOFOG would like to continue with educative programs about the appropriate therapy for OASIS. PMID:25545893

  20. Ileal pouch-anal anastomosis: Points of controversy.

    PubMed

    Trigui, A; Frikha, F; Rejab, H; Ben Ameur, H; Triki, H; Ben Amar, M; Mzali, R

    2014-09-01

    Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most commonly used procedure for elective treatment of patients with ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in order to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. In this review of the literature of restorative proctocolectomy with ileal pouch-anal anastomosis, we discuss these technical modifications, limiting our discussion to the current points of controversy. The current "hot topics" for debate are: indications for ileal pouch-anal or ileo-rectal anastomosis, indications for pouch surgery in the elderly, indeterminate colitis and Crohn's disease, the place of the laparoscopic approach, transanal mucosectomy with hand-sewn anastomosis vs. the double-stapled technique, the use of diverting ileostomy and the issue of the best route for delivery of pregnant women. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with ongoing prospective evaluation of the procedure are required to settle these issues. PMID:24999229

  1. Heterosexual anal intercourse among men in Long Beach, California.

    PubMed

    Hess, Kristen L; Reynolds, Grace L; Fisher, Dennis G

    2014-01-01

    Anal intercourse poses a greater risk for human immunodeficiency virus (HIV) transmission than vaginal intercourse, and in recent years there has been a growing understanding that heterosexual anal intercourse (HAI) is not uncommon. However, the majority of the anal intercourse literature has focused on men who have sex with men. The little research on HAI has mostly looked at women, with limited work among men. This analysis examined the association between HAI and high-risk behaviors (N = 1,622) and sexual sensation seeking (N = 239) in a sample of men recruited from 2001 to 2012 in Long Beach, California. Almost half of the sample was non-Hispanic Black. The median age was 42 years, 42% were homeless, and 20% reported recent HAI. Men who reported HAI were likely to be Hispanic, were likely to be homeless, had a male partner, engaged in sex exchange, and used cocaine or amphetamines during sex. Men who reported HAI scored higher on the Sexual Sensation Seeking scale. This research supports other work showing the relationship between HAI and high-risk behaviors. More important, it contributes new knowledge by demonstrating the association between HAI and sexual sensation seeking. This research highlights the importance of personality traits when trying to understand sexual behavior and when developing HIV prevention interventions. PMID:24024565

  2. Gender Differences in Factors Associated With Anal Intercourse Among Heterosexual Adolescents in Singapore.

    PubMed

    Ng, Junice Y S; Wong, Mee-Lian; Chan, Roy K W; Sen, Priya; Chio, Martin T W; Koh, David

    2015-08-01

    Using a cross-sectional survey, we examined the gender differences in prevalence of and factors associated with anal sex among adolescents attending the only public STI clinic in Singapore. Data were collected from 1035 sexually active adolescents aged 14 to 19 and analyzed using Poisson regression. Prevalence of anal intercourse was 28%, with significantly more females (32%) than males (23%) ever engaged in it. On multivariate analysis, the factors associated with anal intercourse for both genders were oral sex and the nonuse of contraception at last sex. For males, anal intercourse was associated with younger age of sexual debut and greater perceived external control. Among females, it was associated with higher rebellious scores and lack of confidence to resist peer pressure to engage in sex. Consistent condom use for anal sex was 22% and 8% for males and females, respectively. STI prevention programs for adolescents should address anal sex, be gender-specific, and take into consideration individual personality characteristics. PMID:26241386

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

    PubMed

    Carvalho, Newton Sérgio de; Ferreira, Aliana Meneses; Bueno, Camila Caroline Tremel

    2011-01-01

    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. PMID:22230855

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

    PubMed Central

    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

  5. Anal Pap Screening for HIV-infected Men Who Have Sex With Men: Practice Improvement.

    PubMed

    Welbeck, Monique

    2016-01-01

    HIV-infected men who have sex with men (MSM) have the highest rates of anal dysplasia and anal cancer when compared to HIV-uninfected MSM and when compared to HIV-infected heterosexual men and women. Despite significantly increasing rates of anal dysplasia and anal cancer in HIV-infected MSM, in many settings, no standard protocol is in place to screen for anal dysplasia in this high-risk group. A practice improvement project was conducted at a primary care health center to educate the HIV health care team about anal Pap screening in an effort to increase provider knowledge and rates of anal Pap screening performed as part of primary comprehensive care for HIV-infected MSM. Increased health care provider knowledge of anal Pap screening within this setting resulted in increased anal Pap screening for HIV-infected MSM. Routine screening leads to improved surveillance and treatment of precancerous lesions, decreasing morbidity and mortality in HIV-infected MSM. PMID:26427364

  6. Incidence and epidemiology of anal cancer in the Multicenter AIDS Cohort Study (MACS)

    PubMed Central

    D’Souza, Gypsyamber; Wiley, Dorothy J.; Li, Xiuhong; Chmiel, Joan S.; Margolick, Joseph B.; Cranston, Ross D.; Jacobson, Lisa P.

    2014-01-01

    Objective To examine the incidence and risk factors for anal cancer in a multicenter cohort of HIV-positive and negative men who have sex with men followed between 1984 and 2006 (MACS). Methods Prospective analysis using Poisson regression and Cox proportional hazard models, and a nested case-control study using conditional logistic regression. Results There were 28 cases of anal cancer among the 6,972 men who were evaluated. The incidence rate was significantly higher in HIV-positive men than in HIV-negative men (IR= 69 vs. 14 per 100,000 person-years). Among HIV-positive men, anal cancer incidence was higher in the HAART era than the pre-HAART era (IR=137 vs. 30 per 100,000 person-years). In multivariate analysis restricted to the HAART era, anal cancer risk increased significantly with HIV infection (RH=4.7, 95%CI=1.3–17), and increasing number of unprotected receptive anal sex partners at the first three study visits (p-trend=0.03). Among HIV-positive men, current HAART use did not decrease anal cancer risk. Conclusion HIV-positive men had increased risk of anal cancer. Improved survival of HIV-positive individuals following HAART initiation may allow for sufficient time for human papillomavirus (HPV) associated anal dysplasias to develop into malignancies, thus explaining the increased incidence of anal cancer in the HAART era. PMID:18614927

  7. The impact of anaemia on treatment outcome in patients with squamous cell carcinoma of anal canal and anal margin

    PubMed Central

    Cesnjevar, Monika; Anzic, Mitja; Hadzic, Jasna But; Ermenc, Ajra Secerov; Anderluh, Franc; Velenik, Vaneja; Jeromen, Ana; Korosec, Peter

    2016-01-01

    Background Radiochemotherapy is the main treatment for patients with squamous cell carcinoma of the anal canal. Anaemia is reported to have adverse effect on survival in cancer patients. The aim of the study was to evaluate the influence of anaemia on radiochemotherapy treatment outcome in patients with squamous cell carcinoma of the anal canal. Patients and methods One hundred consecutive patients with histologically confirmed squamous cell carcinoma of the anal canal were treated radically with 3-dimensional conformal or intensity-modulated radiation therapy followed by brachytherapy or external beam radiotherapy boost and with concurrent mitomycin C and 5-fluorouracil. The influence on survival of pre-treatment, mean on-treatment and end-of-treatment haemoglobin (Hb) concentrations was studied. Results The 5-year locoregional control, disease free survival, disease specific survival and overall survival rates for all patients were 72%, 71%, 77% and 62%, respectively. In univariate analysis, patients with pre-treatment and end-of-treatment Hb > 120 g/L survived statistically significantly better compared to patients with Hb ≤ 120 g/L. Patients with mean on-treatment Hb > 120 g/L only had statistically significant better locoregional control and overall survival than patients with Hb ≤ 120 g/L. In multivariate analysis, independent prognostic factors were pre-treatment Hb (> 120 g/L vs. ≤ 120 g/L) for overall survival (hazard ratio [HR] = 0.419, 95% confidence interval [CI] = 0.190–0.927, p = 0.032) and stage (I & II vs. III) for disease specific (HR = 3.523, 95% CI = 1.375–9.026, p = 0.009) and overall survival (HR = 2.230, 95% CI = 1.167–4.264, p = 0.015). Conclusions The pre-treatment, mean on-treatment and end-of-treatment Hb concentration > 120 g/L carried better prognosis for patients for with squamous cell carcinoma of the anal canal treated with radiochemotherapy. The pre-treatment Hb > 120 g/L was an independent prognostic factor for overall

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

    PubMed Central

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

    2011-01-01

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

  9. Changing Patterns of Anal Canal Carcinoma in the United States

    PubMed Central

    Nelson, Rebecca A.; Levine, Alexandra M.; Bernstein, Leslie; Smith, David D.; Lai, Lily L.

    2013-01-01

    Purpose Persistent human papillomavirus infection is associated with squamous cell carcinoma of the anal canal (SCCA). With changing sexual behaviors, SCCA incidence and patient demographics may also have changed in recent years. Methods The Surveillance, Epidemiology, and End Results public-use data set from 1973 to 2009 was analyzed to determine incidence trends for and demographic factors characterizing SCCA. Joinpoint analyses identified time points when incidence rates changed. For comparison, similar analyses were conducted for anal adenocarcinoma. Results Joinpoint analyses identified 1997 as the single inflection point among 11,231 patients with SCCA, at which the slope of incidence rates statistically increased (1997 to 2009 v 1973 to 1996: risk ratio [RR], 2.2; 95% CI, 2.1 to 2.3). Annual percent change (APC) increased for all SCCA stages and was the greatest for anal carcinoma in situ (CIS; APC, 14.2; 95% CI, 10.2 to 18.4). Demographic changes characterizing later versus earlier time period included younger age at diagnosis and rising incidence rates in all stage, sex, and racial groups. During 1997 to 2009, women were less likely to present with CIS (RR, 0.3; 95% CI, 0.3 to 0.3) but more likely to present with localized (RR, 1.2; 95% CI, 1.1 to 1.3) and regional SCCA (RR, 1.5; 95% CI, 1.4 to 1.7). In contrast, adenocarcinoma APCs among 1,791 patients remained stable during this time period. Conclusion CIS and SCCA incidence increased dramatically after 1997 for men and women, although men were more likely to be diagnosed with CIS. These changes likely resulted from available screening in men and argue for efforts to identify high-risk individuals who may benefit from screening. PMID:23509304

  10. A rare case of leiomyoma of the internal anal sphincter

    PubMed Central

    Sturiale, Alessandro; Fabiani, Bernardina; Naldini, Gabriele

    2016-01-01

    Introduction Leiomyoma is a benign tumour which derives from the smooth muscle fibres and it may occurs in every site in which this type of muscle is present. Among all benign soft tissue tumours it represents almost 3.8% and its pathogenesis remains still unknown. Presentation of case The present case is about a 62 year old woman referred to our centre complaining anal and perineal pain which increase after defecation in association with the appearance of a nodule in the perianal region fixed to the anal sphincter. A 360° tridimensional transanal ultrasound was performed and it showed an anterior nodular thickening of the internal anal sphincter. After an inconclusive preoperative biopsy and a counselling with the patient, the surgeons decided to proceed with the surgical excision. The immunohistochemical examination confirmed the preoperative suspicion of leiomyoma. At 1 year follow-up the patient had not tumour-related symptoms or fecal incontinence and any signs of local recurrence at ultrasound imaging were demonstrated. Discussion Leiomyomas are relatively insensitive to chemotherapy whereby surgery is the treatment of choice and it should be adequate to the site and dimension of the lesion achieving a complete resection with free margins. A further close follow-up is needed too. Conclusion Nowadays there is not a gold standard technique to treat such kind of lesions and the decision of the best surgical approach should depend on the dimension and site. In fact, surgery aims to the oncological outcome trying also to minimize the possible post-operative functional complications. PMID:27078867

  11. [The time of proctectomy during ileo-anal anastomosis].

    PubMed

    Hautefeuille, P

    1993-01-01

    Proctectomy is one of the most important operative phases of ileal pouch-anal anastomosis. It allows complete resection of the rectal mucosa and determines the quality of the postoperative course and the functional results. Two procedures are described, either with a distal rectal mucosectomy or complete resection of the rectal wall as far as the pectinate line. Functional results are identical. The second procedure leads to a complete resection of the rectal mucosa and therefore will be indicated in cases of low rectal cancer of dysplasia when the anus can be preserved. PMID:8161140

  12. Ileo-anal pouch procedure: experience in the Chinese population.

    PubMed

    Lau, P W; Boey, J; Lorentz, T G

    1991-11-01

    The ileo-anal pouch procedure is now a well-established method for dealing with ulcerative colitis and familial polyposis in many centres in the West. Experience in the Chinese population is not well documented, mainly due to the rarity of inflammatory bowel disease. This report documents the experience of a university teaching hospital in Hong Kong. Despite being a small series, the low complication rates and good functional results show that the pelvic pouch procedure has now evolved to a stage where it can be performed safely even in centres with infrequent experience. PMID:1661110

  13. Biomaterials in the Treatment of Anal Fistula: Hope or Hype?

    PubMed Central

    Scoglio, Daniele; Walker, Avery S.; Fichera, Alessandro

    2014-01-01

    Anal fistula (AF) presents a chronic problem for patients and colorectal surgeons alike. Surgical treatment may result in impairment of continence and long-term risk of recurrence. Treatment options for AFs vary according to their location and complexity. The ideal approach should result in low recurrence rates and minimal impact on continence. New technical approaches involving biologically derived products such as biological mesh, fibrin glue, fistula plug, and stem cells have been applied in the treatment of AF to improve outcomes and decrease recurrence rates and the risk of fecal incontinence. In this review, we will highlight the current evidence and describe our personal experience with these novel approaches. PMID:25435826

  14. Adynamic and dynamic muscle transposition techniques for anal incontinence

    PubMed Central

    Barišić, Goran; Krivokapić, Zoran

    2014-01-01

    Gracilis muscle transposition is well established in general surgery and has been the main muscle transposition technique for anal incontinence. Dynamization, through a schedule of continuous electrical stimulation, converts the fatigue-prone muscle fibres to a tonic fatigue-resistant morphology with acceptable results in those cases where there is limited sphincter muscle mass. The differences between gluteoplasty and graciloplasty, as well as the techniques and complications of both procedures, are outlined in this review. Overall, these techniques are rarely carried out in specialized units with experience, as there is a high revision and explantation rate. PMID:24759348

  15. Invited commentary: Biological and clinical insights from epidemiologic research into HIV, HPV, and anal cancer.

    PubMed

    Engels, Eric A; Madeleine, Margaret M

    2013-09-15

    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

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

    PubMed Central

    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

  17. Anal Intercourse and Sexual Risk Factors among College Women, 1993-2000

    ERIC Educational Resources Information Center

    Flannery, Diana; Ellingson, Lyndall; Votaw, Karen S.; Schaefer, Elizabeth Ann

    2003-01-01

    Objective: To determine trends and sexual risk behaviors associated with anal intercourse among college women over an 8-year period. Methods: A sexual activity questionnaire was used to collect data from 813 students enrolled in a women's health course. Results: Thirty-two percent of the women had engaged in anal intercourse, and this measure was…

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

    ERIC Educational Resources Information Center

    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 sought.…

  19. Adenocarcinoma arising from an anal gland—Report of a case

    PubMed Central

    Sakamoto, Takashi; Konishi, Fumio; Yoshida, Takayoshi; Yoshinaga, Yasuo; Izumo, Toshiyuki; Lefor, Alan

    2014-01-01

    INTRODUCTION Adenocarcinoma arising from an anal gland is extremely rare. Most anal canal cancers are squamous cell carcinoma, and adenocarcinoma is infrequently diagnosed. Diagnostic criteria and the standard treatment for adenocarcinoma of the anal canal have not been clearly defined, in part because of the rarity of this lesion. PRESENTATION OF CASE An 84-year-old man who presented with a piece of tissue prolapsing from the anus. An incisional biopsy showed adenocarcinoma, and an abdomino-perineal resection was then performed. Cytokeratin 7 (CK7), cytokeratin 19 (CK19) stained positive in the specimen, suggesting that the tumor developed from an anal gland. The patient was discharged after surgery without any complications. DISCUSSION Exact diagnostic criteria for adenocarcinoma of the anal canal have not been previously described. In the present case, CK7 and CK19 were stained, and the tumor showed positivity for both of these markers, which is compatible with the staining patterns of anal gland origin cancer. Radical resection is recommended rather than local resection, because of the tumor's high recurrence rate. Some authors recommend combined modality treatment with preoperative or postoperative chemoradiotherapy because of the high rate of distant recurrence. CONCLUSION The preoperative diagnosis of adenocarcinoma arising from an anal gland is not easily established. However, it may be possible to suspect an anal glandular adenocarcinoma based on a meticulous physical examination, appropriate diagnostic studies and pathological findings on biopsy. PMID:24705191

  20. New method for assessment of anal sensation in various anorectal disorders.

    PubMed

    Roe, A M; Bartolo, D C; Mortensen, N J

    1986-04-01

    A new technique for quantifying anal sensation utilizing mucosal electrosensitivity is described and has been tested in 97 patients. Normal subjects (n = 20) have a sensory threshold varying from 2 to 7.3 mA being most acute in the region of the anal valves. Sensory awareness also extends into the upper anal canal. Patients with neuropathic incontinence (n = 17) have a sensory deficit (P less than 0.002) whilst patients with haemorrhoids (n = 28) have less sensitive mucosa displaced into the upper anal canal (P less than 0.0001). Patients with acute fissure-in-ano (n = 10) have lower thresholds of sensation at the site of the fissure and slow transit constipation patients (n = 22) have normal anal sensation. The technique is reproducible and should prove useful in the investigation of anorectal disorders. PMID:3697665

  1. [Early detection of anal intraepithelial neoplasia in high-risk patients].

    PubMed

    Sendagorta, E; Herranz, P; Guadalajara, H; Zamora, F X

    2011-12-01

    The incidence of anal squamous cell carcinoma has increased alarmingly, particularly in high-risk groups such as men who have sex with men and immunosuppressed patients. Infection with an oncogenic strain of the human papillomavirus in the anal canal or perianal skin leads to anal intraepithelial neoplasias (AIN), progressive dysplastic intraepithelial lesions that are the precursors of anal squamous cell carcinoma. AIN can be diagnosed through cytological screening and biopsy guided by high-resolution anoscopy and can be treated using a range of procedures in an effort to prevent progression to invasive anal carcinoma. Given the recent advances in the understanding of this disease, and the increasing calls from experts for the establishment of screening programs to identify AIN, we review current knowledge on the condition, its diagnosis, and treatment from the point of view of dermatology. PMID:21764027

  2. The magnetic anal sphincter: a new device in the management of severe fecal incontinence.

    PubMed

    Mantoo, Surendra; Meurette, Guillaume; Podevin, Juliette; Lehur, Paul-Antoine

    2012-09-01

    The authors aim to report the concept and technique of implantation and the first results of the clinical use of the magnetic anal sphincter (MAS) in the management of fecal incontinence (FI). The MAS device is designed to augment the native anal sphincter. The implant is a series of titanium beads with magnetic cores linked together with independent titanium wires. To defecate, the force generated by straining separates the beads to open up the anal canal. The technique of implantation is simple with no requirement of adjustments. The MAS has a role in the management of severe FI. The device has acceptable and comparable adverse effects to other therapies. FI and Fecal Incontinence Quality of Life scores are significantly improved in the short term. The MAS offers a simple and less invasive option of anal reinforcement. It is one step further in the quest for an ideal artificial anal sphincter device. PMID:23116075

  3. Peri-anal implantation of bioengineered human internal anal sphincter constructs intrinsically innervated with human neural progenitor cells

    PubMed Central

    Raghavan, Shreya; Miyasaka, Eiichi A.; Gilmont, Robert R.; Somara, Sita; Teitelbaum, Daniel H.; Bitar, Khalil N.

    2014-01-01

    Background The internal anal sphincter (IAS) is a major contributing factor to anal canal pressure and is required for maintenance of rectoanal continence. IAS damage or weakening results in fecal incontinence. We have demonstrated that bioengineered intrinsically innervated human IAS tissue replacements possess key aspects of IAS physiology, like generation of spontaneous basal tone and contraction/relaxation in response to neurotransmitters. The objective of this study is to demonstrate the feasibility of implantation of bioengineered IAS constructs in the peri-anal region of athymic rodents. Methods Human IAS tissue constructs were bioengineered from isolated human IAS circular smooth muscle cells and human enteric neuronal progenitor cells. Upon maturation of the bioengineered constructs in culture, they were implanted surgically into the perianal region of athymic rats. Growth factor was delivered to the implanted constructs through a microosmotic pump. Implanted constructs were retrieved from the animals 4 weeks post-implantation. Results Animals tolerated the implantation well, and there were no early postoperative complications. Normal stooling was observed during the implantation period. Upon harvest, implanted constructs were adherent to the perirectal rat tissue, and appeared healthy and pink. Immunohistochemical analysis revealed neovascularization. Implanted smooth muscle cells maintained contractile phenotype. Bioengineered constructs responded to neuronally evoked relaxation in response to electrical field stimulation and vasoactive intestinal peptide, indicating the preservation of neuronal networks. Conclusions Our results indicate that bioengineered innervated IAS constructs can be used to augment IAS function in an animal model. This is a regenerative medicine based therapy for fecal incontinence that would directly address the dysfunction of the IAS muscle. PMID:24582493

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

    PubMed Central

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

    2012-01-01

    Objective: The anal sex among heterosexual couples is on the rise as reported in many scientific studies. Considering that unprotected anal sex has higher risk of human immunodeficiency virus (HIV) transmission than the vaginal sex, we undertook a study to understand the anal sex practices among Female Sex Workers (FSW). Materials and Methods: The study was conducted among FSW attending 11 randomly selected sexually transmitted infection (STI) clinics in Bill and Melinda Gates supported targeted interventions in Andhra Pradesh. A structured questionnaire was administered to the 555 FSW attending these clinics by project clinic counselors. Informed consent was obtained from all the study participants. Results: Engaging in anal sex was self reported by 22% of sex workers, though demand from clients was reported to be much higher (40%). The reasons for anal sex practices included more money (61%), clout/influence of the client (45%), risk of losing client (27%), and forced sex (1.2%). Factors associated with anal sex were higher number of clients, higher duration of sex work, higher income, and older age group. Associated risks perceived by FSW were bleeding and injury to anal canal (98%) while only 28% associated it with higher HIV transmission risk. Reported Condom and lubricant use was about 88% and 39% respectively. Conclusion: The study shows that there is frequent anal sex, inconsistent condom and infrequent lubricant usage, economic and physical coercion, and low awareness of STI/HIV transmission risk among FSW, which have serious implications for HIV prevention programmes. There is a need to focus on anal sex education and use of lubricants along with condoms during anal sex in FSW-targeted interventions in AP. PMID:22529447

  5. A case of syphilitic anal condylomata lata mimicking malignancy

    PubMed Central

    Tayal, Sarup; Shaban, Fadlo; Dasgupta, Kaushik; Tabaqchali, Mohamed A.

    2015-01-01

    Introduction Condylata lata in secondary syphilis is well known presentation and needs to be considered in differential diagnosis of perianal lesions. In England between 2013 and 2014 the overall incidence of infectious syphilis increased by 33% and is mainly seen in men who have sex with men. Presentation of case We report the management of a 49-years-old Caucasian homosexual man with perianal lesions that were suspicious of malignancy. After biopsies, colonoscopy, staging with computed tomography, magnetic resonance imaging and syphilis serology anal cancer was excluded and a diagnosis of syphilis was confirmed. He was referred to the sexual health clinic for the appropriate investigations and treatment. Discussion This case highlights the consideration of treatable infectious syphilis pathology. The main differential diagnosis of perianal growths to consider is condylomata acuminata (warts caused by human papillomavirus), anal cancer, syphilis, chancroid, haemorrhoids, tuberculosis and lymphogranuloma venereum. To differentiate a biopsy is needed for histopathological examination. A dense plasma cell infiltrate and numerous spirochetes visualised by immunostaining confirms condylomata lata. Conclusion In UK, it is important for colorectal surgeons to be aware of syphilitic condylomata lata and consider this when dealing with perianal lesions. It is advisable to refer patients suspected of or diagnosed with syphilis to sexual health clinics to help improve outcome. In sexual health clinics additional investigations and treatment are available in addition to partner notification and follow-up can be offered. PMID:26555060

  6. Comprehensive multiplatform biomarker analysis of 199 anal squamous cell carcinomas

    PubMed Central

    Smaglo, Brandon G.; Tesfaye, Anteneh; Halfdanarson, Thorvardur R.; Meyer, Joshua E.; Wang, Jue; Gatalica, Zoran; Reddy, Sandeep; Arguello, David; Boland, Patrick M.

    2015-01-01

    Anal squamous cell carcinoma (ASCC) is a rare, HPV-associated malignancy typically diagnosed in early stages and definitively treated with chemoradiation. In situations where patients exhibit metastatic or recurrent disease, treatment options are severely limited. In this study, molecular alterations were identified that could be used to aid in therapeutic decisions for patients with metastatic or recurrent anal squamous cell carcinoma. Specimens from patients with this cancer were tested via a multiplatform profiling service (Caris Life Sciences, Phoenix, AZ) consisting of gene sequencing, protein expression by immunohistochemistry, and gene amplification with in situ hybridization. Utilizing these techniques, novel treatment strategies that could be explored were identified, including potential benefit with anti-EGFR therapies, immune checkpoint inhibitors, topoisomerase inhibitors, and taxanes. The frequency of overexpression of proteins that mark resistance to chemotherapeutic drugs, such as MRP1 (chemotherapy efflux pump), ERCC1 (resistance to platinum-based chemotherapy), and thymidylate synthase (resistance to fluoropyrimidines) were also identified, suggesting a lack of benefit. This multiplatform strategy could be explored for its potential to generate a personalized treatment selection for patients with advanced ASCC, provide a guide for future therapeutic development for this cancer, and be extended to other rare cancer types as well. PMID:26498363

  7. The hero, the anima and the claustrum: anality and idealization.

    PubMed

    Meredith-Owen, William

    2012-04-01

    Joe Redfearn's (1979) classic paper 'The captive, the treasure, the hero and the anal stage of development' is recognized as seminal to the development of Jungian thought about anality, particularly its integration with mainstream (Freudian, Kleinian) psychoanalytic perspectives. This paper develops such an approach through drawing on contributions from Meltzer, Green, Bion, Chasseguet-Smirgel and Kernberg. More specifically, it is argued that over-investment in hero and anima archetypal configurations may represent an attempt to replace the resource of the internal parental couple that, at the level of unconscious phantasy, has been destroyed by the aggrieved child's attack on the primal scene. Unless this usually dissociated sadism can be integrated, the creative epistemophilic instinct may remain blunted, giving rise, through projective identification, to the adoption of a pseudo-adult identity based on appropriation or assertion. This in turn may lead to manic attempts to reach authentic ('animating') experience through the (often erotized) excitement of heroic endeavour. Consideration of both Redfearn's and the author's own clinical material demonstrates how close attention to process as well as content is fundamental to revealing and addressing such likely-to-be dissociated scenarios. PMID:22444354

  8. Comprehensive multiplatform biomarker analysis of 199 anal squamous cell carcinomas.

    PubMed

    Smaglo, Brandon G; Tesfaye, Anteneh; Halfdanarson, Thorvardur R; Meyer, Joshua E; Wang, Jue; Gatalica, Zoran; Reddy, Sandeep; Arguello, David; Boland, Patrick M

    2015-12-22

    Anal squamous cell carcinoma (ASCC) is a rare, HPV-associated malignancy typically diagnosed in early stages and definitively treated with chemoradiation. In situations where patients exhibit metastatic or recurrent disease, treatment options are severely limited. In this study, molecular alterations were identified that could be used to aid in therapeutic decisions for patients with metastatic or recurrent anal squamous cell carcinoma. Specimens from patients with this cancer were tested via a multiplatform profiling service (Caris Life Sciences, Phoenix, AZ) consisting of gene sequencing, protein expression by immunohistochemistry, and gene amplification with in situ hybridization. Utilizing these techniques, novel treatment strategies that could be explored were identified, including potential benefit with anti-EGFR therapies, immune checkpoint inhibitors, topoisomerase inhibitors, and taxanes. The frequency of overexpression of proteins that mark resistance to chemotherapeutic drugs, such as MRP1 (chemotherapy efflux pump), ERCC1 (resistance to platinum-based chemotherapy), and thymidylate synthase (resistance to fluoropyrimidines) were also identified, suggesting a lack of benefit. This multiplatform strategy could be explored for its potential to generate a personalized treatment selection for patients with advanced ASCC, provide a guide for future therapeutic development for this cancer, and be extended to other rare cancer types as well. PMID:26498363

  9. Value of human papillomavirus typing for detection of anal cytological abnormalities

    PubMed Central

    Maia, Livia Bravo; Marinho, Larissa Cardoso; Barbosa, Tânia Wanderley Paes; Velasco, Lara Franciele Ribeiro; Costa, Patrícia Godoy Garcia; Carneiro, Fabiana Pirani; de Oliveira, Paulo Gonçalves

    2013-01-01

    Purpose: The objective of this study was to evaluate anal cytology and human papillomavirus (HPV) typing in patients with human immunodeficiency virus infection. Materials and Methods: Anal samples were collected from 61 patients (44 men and 17 women) and analyzed by PapilloCheck test and conventional cytology. Results: Of all anal samples, 37.7% had cytological abnormalities, 47.54% were negative and 14.75% were unsatisfactory. High-risk HPV, multiple high-risk HPV and HPV 16 infection was detected in 91.13%, 78.26% and 47.82% of the samples with cytological abnormalities and in 47.54%, 6.89% and 3.44% of the negative samples, respectively. High-risk HPV infection was significantly more frequent in anal samples with cytological abnormalities than in negative samples (P = 0.0005, Fisher's test), particularly multiple high-risk HPV infection (P < 0.0001) and HPV 16 infection (P = 0.0002). Conclusions: High-risk HPV, multiple high-risk HPV and HPV 16 infections are significantly associated with anal cytological abnormalities. Furthermore, the frequency of HPV infection in anal cytological samples suggests that high-risk HPV detection has high sensitivity, but low specificity for detection of anal cytological abnormalities, but multiple high-risk HPV typing and HPV 16 typing have a lower sensitivity and high specificity. Results suggest that HPV typing may be useful as an adjunct to cytology to screen patients for high-resolution anoscopy and biopsy. PMID:24339460

  10. The epidemiology and natural history of anal human papillomavirus infection in men who have sex with men.

    PubMed

    Machalek, Dorothy A; Grulich, Andrew E; Jin, Fengyi; Templeton, David J; Poynten, I Mary

    2012-12-01

    Studies on the epidemiology and natural history of anal human papillomavirus (HPV) infection are essential to understand the significance of this virus in the aetiology of anal cancer in men who have sex with men (MSM). This paper presents a review of studies on anal HPV in MSM. For this review, a Medline search was performed to identify English-language articles published in peer-reviewed journals on the epidemiology, natural history and risk factors for anal HPV infection in MSM. Anal HPV prevalence is high in MSM and infection with multiple HPV types is common. The available prospective data suggest detection of new anal HPV infections may also be common. However, with limited epidemiological data available on infection dynamics and associated behavioural risk factors, it is difficult to draw conclusions on how persistent anal HPV infection is in this population. PMID:23380235

  11. Complex rectal and anal canal injuries secondary to unusual blunt perineal trauma.

    PubMed

    El Lakis, Mustapha A; Rida, Khaled; Nakhle, Ram; Abi Saad, George

    2014-01-01

    A 27-year-old woman sustained a trauma to her perineal area when she was ejected from a jet ski while riding on water at high speed. The patient presented to the emergency department with blood streaking from her anal canal. Imaging revealed pneumoperitoneum. Surgical intervention showed complex anal canal and rectal injuries. Primary repair of the injuries was performed. Postoperatively the patient did well and was followed up with no evidence of residual symptoms and with a continent anal sphincter. PMID:25352384

  12. Anal signs of child sexual abuse: a case–control study

    PubMed Central

    2014-01-01

    Background There is uncertainty about the nature and specificity of physical signs following anal child sexual abuse. The study investigates the extent to which physical findings discriminate between children with and without a history of anal abuse. Methods Retrospective case note review in a paediatric forensic unit. Cases: all eligible cases from1990 to 2007 alleging anal abuse. Controls: all children examined anally from 1998 to 2007 with possible physical abuse or neglect with no identified concern regarding sexual abuse. Fisher’s exact test (two-tailed) was performed to ascertain the significance of differences for individual signs between cases and controls. To explore the potential role of confounding, logistic regression was used to produce odds ratios adjusted for age and gender. Results A total of 184 cases (105 boys, 79 girls), average age 98.5 months (range 26 to 179) were compared with 179 controls (94 boys, 85 girls) average age 83.7 months (range 35–193). Of the cases 136 (74%) had one or more signs described in anal abuse, compared to 29 (16%) controls. 79 (43%) cases and 2 (1.1%) controls had >1 sign. Reflex anal dilatation (RAD) and venous congestion were seen in 22% and 36% of cases but <1% of controls (likelihood ratios (LR) 40, 60 respectively), anal fissure in 14% cases and 1.1% controls (LR 13), anal laxity in 27% cases and 3% controls (LR 10). Novel signs seen significantly more commonly in cases were anal fold changes, swelling and twitching. Erythema, swelling and fold changes were seen most commonly within 7 days of last reported contact; RAD, laxity, venous congestion, fissure and twitching were observed up to 6 months after the alleged assault. Conclusions Anal findings are more common in children alleging anal abuse than in those presenting with physical abuse or neglect with no concern about sexual abuse. Multiple signs are rare in controls and support disclosed anal abuse. PMID:24884914

  13. Retrospective Audit of the Management of Anal Insertion of Foreign Bodies: A Holistic Approach

    PubMed Central

    Yahya, Ahmed; Chukwuma, Jude

    2016-01-01

    Most patients with voluntary anal insertion of a foreign body (IFB) present to the emergency department and are then managed by the surgical team. This report reviews the medical literature on IFB and includes results of a chart review of operative logged interventions and clinically coded procedures for anal IFBs at a single acute hospital in the United Kingdom between May 2009 and September 2013. The objective was to establish the current practice in the management of anal IFB and update a framework for the initial workup, surgical procedure, and appropriate mental health intervention. PMID:27247831

  14. Technical aspects of radiation therapy for anal cancer

    PubMed Central

    Scher, Eli D.; Ahmed, Inaya; Yue, Ning J.

    2014-01-01

    Historically treated with surgery, current practice recommends anal carcinoma to be treated with a combination of chemotherapy and radiation. This review will examine the anatomy, modes of disease spread and recurrence, and evaluate the existing evidence for treatment options for these tumors. An in-depth examination of specific radiation therapy (RT) techniques—such as conventional 3D-conformal RT and intensity-modulated RT—will be discussed along with modern dose constraints. RT field arrangement, patient setup, and recommended gross and clinical target volume (CTV) contours will be considered. Areas in need of further investigation, such as the role in treatment for positron emission tomography (PET) will be explored. PMID:24982768

  15. Anal sphincter injury. Management and results of Parks sphincter repair.

    PubMed Central

    Browning, G G; Motson, R W

    1984-01-01

    The surgical management of a consecutive series of 97 patients with complete division of the anal sphincter musculature is reported. The sphincter damage followed operative, traumatic, or obstetric injury and resulted in frank fecal incontinence or the urgent necessity of a defunctioning colostomy. All patients were treated by delayed sphincter repair using an overlapping technique; in 93 the repair was protected by a temporary defunctioning stoma. There were no deaths. The repair was completely successful in 65 (78%) and partially successful in 11 (13%) of the 83 patients assessed from 4 to 116 months after surgery. Complications occurred in 27 patients but did not usually affect the eventual clinical outcome. Provided there has been no major neurological damage to the sphincter complex, surgical reconstruction can be expected to restore continence in most patients. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. PMID:6703796

  16. Planar spin-transfer device with dynamical polarizer and analizer

    NASA Astrophysics Data System (ADS)

    Bazaliy, Yaroslaw; Kravchenko, Anton

    2011-03-01

    The behavior of the planar spin-transfer devices with monodomain magnetic layers can be described by the macrospin Landau-Lifshitz-Gilbert (LLG) equation with spin-transfer terms. The LLG description of a device with two layers is simplified after applying the overdamped, large easy-plane anisotropy approximation. A decrease of the magnetic layer thickness asymmetry creates a transition from the conventional polarizer-analizer (``fixed layer -- free layer'') operation regime to the regime of the nearly identical magnets. Here electric current leads to a ``Slonczewski windmill'' dynamic state, rather than producing the magnetic switching. The ``windmill'' precession state of a device with two free layers was investigated by numerical solution of the LLG equation.

  17. The epidemiology of anal incontinence and symptom severity scoring

    PubMed Central

    Nevler, Avinoam

    2014-01-01

    For many patients, anal incontinence (AI) is a devastating condition that can lead to social isolation and loss of independence, contributing to a substantial economic health burden, not only for the individual but also for the allocation of healthcare resources. Its prevalence is underestimated because of poor patient reporting, with many unrecorded but symptomatic cases residing in nursing homes. Endosonography has improved our understanding of the incidence of post-obstetric sphincter tears that are potentially suitable for repair and those cases resulting from anorectal surgery, most notably after fistula and hemorrhoid operations. The clinical scoring systems assessing the severity of AI are discussed in this review, along with their limitations. Improvements in the standardization of these scales will advance our understanding of treatment response in an era where the therapeutic options have multiplied and will permit a better comparison between specific therapies. PMID:24759339

  18. [Preservation of the anal sphincter in low rectal lesions].

    PubMed

    Arthur, K E; Guerra, M

    1997-01-01

    We have discussed the surgical options to save the anorectal sphincter in lesions within the lower 2/3 of the rectum. We presented four clinical cases: two villous adenomas, one adenocarcinoma and one benign tumor, probably of embryonic origin. We discussed the surgical options in order to avoid a permanent colostomy. There is not a single surgical procedure that we can count on to preserve the anal sphincter, either in benign or malignant lesions. The surgeons treating this pathology should consider all options and be able to select the most adequate, the less complicated and yet be able to preserve continence. The surgeons should remember that in treating malignant lesions "a curative resection is worth a colostomy". PMID:9805095

  19. Human papillomavirus-related squamous cell carcinoma of the anal canal with papillary features

    PubMed Central

    Leon, Marino E; Shamekh, Rania; Coppola, Domenico

    2015-01-01

    Human papillomavirus (HPV) related squamous cell carcinoma (SCC) involving the anal canal is a well-known carcinoma associated with high-risk types of HPV. HPV-related SCC with papillary morphology (papillary SCC) has been described in the oropharynx. We describe, for the first time, a case of anal HPV-related squamous carcinoma with papillary morphology. The tumor arose from the anal mucosa. The biopsies revealed a superficially invasive SCC with prominent papillary features and associated in situ carcinoma. The tumor cells were positive for p16 and were also positive for high-risk types of HPV using chromogenic in situ hybridization. The findings are consistent with a HPV-related SCC of the anal canal with papillary features. This tumor shows histologic features similar to a papillary HPV-related SCC of the oropharynx. Additional studies are needed to characterize these lesions. PMID:25717259

  20. Histochemical properties of sialic acids and antimicrobial substances in canine anal glands

    PubMed Central

    Nara, T.; Yasui, T.; Fujimori, O.; Meyer, W.; Tsukise, A.

    2011-01-01

    The functional properties of sialic acids appear to be manifold. Additionally, antimicrobial substances serve as a non-specific defense against microorganisms. In this study, therefore, the localization of sialic acids and antimicrobial substances in the anal glands of dog was studied by sialoglycoconjugate histochemistry and immunohistochemistry. The secretory epithelium, luminal secretions and excretory ducts exhibited high levels of sialoglycoconjugates that terminated in Siaα2-6Gal/GalNAc or Siaα2-3Gal1-4GlcNAc. Additionally, O-acetylated sialic acids were detectable in these glandular structures. Antimicrobial substances, such as lysozyme, immunoglobulin A (IgA), lactoferrin and the peptide group of β-defensins, were also demonstrated as products of the anal glands. The results obtained are discussed with regard to the functional significance of the anal glands. These secretory products may create a defensive barrier against microbial invasion at the anal mucosa. PMID:22073376

  1. [The usefulness of manometry in the determination of the morphology of the anal canal].

    PubMed

    Gil-Vernet, J M; Asensio, M; Marhuenda, C; Broto, J; Lloret, J; Boix-Ochoa, J

    1997-07-01

    The appearance of the new lecture systems for the manometry studies by computer, like the Polygram by Synectics (vector volume), offer the possibility to see the circumferential pressure forces, that even in rest conditions as in voluntary contraction, they keep coaptation of the anal canal, and this will act as a continent closure system in the most distal part of the G.I. tract. The study is with the normal parameters obtained in 14 individuals, considered as normal, getting the mean +/- sd pressure of the anal canal convey in mm Hg, from de anal canal profile in rest as in voluntary contraction, and the maximum variability that could exist between the six profile waves, that are obtained in the same individual to develop an image of the anal canal. This valves will allow the author's to get to the bottom of fecal incontinence derivative from anorectal malformations, defining the pressure valves of muscular hypoplasia or surgical outcomes of the malformations. PMID:9376242

  2. Rare Case of Anal Canal Signet Ring Cell Carcinoma Associated with Perianal and Vulvar Pagetoid Spread

    PubMed Central

    Kim, Na Rae; Cho, Hyun Yee; Baek, Jeong-Heum; Jeong, Juhyeon; Ha, Seung Yeon; Seok, Jae Yeon; Park, Sung Won; Sym, Sun Jin; Lee, Kyu Chan; Chung, Dong Hae

    2016-01-01

    A 61-year-old woman was referred to surgery for incidentally found colonic polyps during a health examination. Physical examination revealed widespread eczematous skin lesion without pruritus in the perianal and vulvar area. Abdominopelvic computed tomography showed an approximately 4-cm-sized, soft tissue lesion in the right perianal area. Inguinal lymph node dissection and Mils’ operation extended to perianal and perivulvar skin was performed. Histologically, the anal canal lesion was composed of mucin-containing signet ring cells, which were similar to those found in Pagetoid skin lesions. It was diagnosed as an anal canal signet ring cell carcinoma (SRCC) with perianal and vulvar Pagetoid spread and bilateral inguinal lymph node metastasis. Anal canal SRCC is rare, and the current case is the third reported case in the English literature. Seven additional cases were retrieved from the world literature. Here, we describe this rare case of anal canal SRCC with perianal Pagetoid spread and provide a literature review. PMID:26447133

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

    Cancer.gov

    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.

  4. A wide field-of-view scanning endoscope for whole anal canal imaging.

    PubMed

    Han, Chao; Huangfu, Jiangtao; Lai, Lily L; Yang, Changhuei

    2015-02-01

    We report a novel wide field-of-view (FOV) scanning endoscope, the AnCam, which is based on contact image sensor (CIS) technology used in commercialized business card scanners. The AnCam can capture the whole image of the anal canal within 10 seconds with a resolution of 89 μm, a maximum FOV of 100 mm × 120 mm, and a depth-of-field (DOF) of 0.65 mm at 5.9 line pairs per mm (lp/mm). We demonstrate the performance of the AnCam by imaging the entire anal canal of pigs and tracking the dynamics of acetowhite testing. We believe the AnCam can potentially be a simple and convenient solution for screening of the anal canal for dysplasia and for surveillance in patients following treatment for anal cancer. PMID:25780750

  5. [A Case of Anal Canal Carcinoma with Inguinal Lymph Node Metastasis Treated with Laparoscopic Abdominoperineal Resection].

    PubMed

    Tonooka, Toru; Takiguchi, Nobuhiro; Yamamoto, Hiroshi; Nabeya, Yoshihiro; Ikeda, Atsushi; Kainuma, Osamu; Soda, Hiroaki; Cho, Akihiro; Saito, Hiroshige; Arimitsu, Hidehito; Yanagibashi, Hiroo; Kobayashi, Ryosuke; Chibana, Tomofumi; Tokoro, Yukinari; Nagata, Matsuo

    2015-11-01

    We report a case of anal canal cancer with inguinal lymph node metastasis treated with laparoscopic abdominoperineal resection combined with inguinal lymph node dissection. A 52-year-old woman was diagnosed with anal squamous carcinoma after excision of an anal canal tumor. Further examination revealed right inguinal lymph node metastasis. Chemoradiotherapy was administered but was discontinued because of serious adverse events. We therefore performed laparoscopic abdominoperineal resection combined with inguinal lymph node dissection. The pathological findings revealed residual squamous cell carcinoma at the lymphatic vessels in the rectal wall and lymph nodes, including the right inguinal region. Therapeutic effect of Grade 1a was achieved in spite of interruption of the chemoradiotherapy. She was discharged 17 days after the operation, and no recurrence was observed for 11 months. Radical resection was performed for the anal canal squamous cell carcinoma with the metastasis to the right inguinal lymph node, even after interruption of the chemoradiotherapy. PMID:26805350

  6. A wide field-of-view scanning endoscope for whole anal canal imaging

    PubMed Central

    Han, Chao; Huangfu, Jiangtao; Lai, Lily L.; Yang, Changhuei

    2015-01-01

    We report a novel wide field-of-view (FOV) scanning endoscope, the AnCam, which is based on contact image sensor (CIS) technology used in commercialized business card scanners. The AnCam can capture the whole image of the anal canal within 10 seconds with a resolution of 89 μm, a maximum FOV of 100 mm × 120 mm, and a depth-of-field (DOF) of 0.65 mm at 5.9 line pairs per mm (lp/mm). We demonstrate the performance of the AnCam by imaging the entire anal canal of pigs and tracking the dynamics of acetowhite testing. We believe the AnCam can potentially be a simple and convenient solution for screening of the anal canal for dysplasia and for surveillance in patients following treatment for anal cancer. PMID:25780750

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

    PubMed

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

    2016-05-01

    Human papillomavirus (HPV) infection is mostly asymptomatic, but may also have many diverse clinical signs encompassing benign ano-genital lesions, and carcinomas. Recently, interest has also particularly focused on anal cancer since, over the last decades, its incidence has been greatly increasing in developed countries, both in women and men and is drastically higher in specific risk groups, such as men who have sex with men (MSM) and HIV-1 infected individuals. Approximately 88% of anal cancer cases worldwide are associated with HPV infection. This review summarizes our current understanding of anal HPV infection, discussing its epidemiology and risk factors in various populations, and the state of the art in the detection of anal HPV infection and its related lesions through both cytology and histology. Finally, we discuss the clinical management and therapy for these lesions. PMID:27050294

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

    PubMed Central

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

    2015-01-01

    Previously ectopic breast tissue was thought to be derived from the caudal remnants of the primitive embryonic milk ridges; anogenital mammary-like glands are presently considered as normal constituents of the anogenital region. We report a case of young female, who presented with an anal papilloma. Histopathological examination revealed extensive fibrocystic changes in anogenital mammary-like glands. To date, a lot of benign changes and a wide range of benign and malignant neoplasms have been reported in these glands. However, extensive fibrocystic change of these glands in anal region is very rare. In addition, fibrocystic disease of anal mammary glands, masquerading clinically as an anal papilloma, has not been reported in literature. Hence, it is essential for clinicians and the pathologists to be aware of such a rare presentation. The features of fibrocystic disease in perianal region are also discussed. PMID:26495147

  9. Comparison of Hybribio GenoArray and Roche human papillomavirus (HPV) linear array for HPV genotyping in anal swab samples.

    PubMed

    Low, Huey Chi; Silver, Michelle I; Brown, Brandon J; Leng, Chan Yoon; Blas, Magaly M; Gravitt, Patti E; Woo, Yin Ling

    2015-02-01

    Human papillomavirus (HPV) is causally associated with anal cancer, as HPV DNA is detected in up to 90% of anal intraepithelial neoplasias and anal cancers. With the gradual increase of anal cancer rates, there is a growing need to establish reliable and clinically relevant methods to detect anal cancer precursors. In resource-limited settings, HPV DNA detection is a potentially relevant tool for anal cancer screening. Here, we evaluated the performance of the Hybribio GenoArray (GA) for genotyping HPV in anal samples, against the reference standard Roche Linear Array (LA). Anal swab samples were obtained from sexually active men who have sex with men. Following DNA extraction, each sample was genotyped using GA and LA. The overall interassay agreement, type-specific, and single and multiple genotype agreements were evaluated by kappa statistics and McNemar's χ(2) tests. Using GA and LA, 68% and 76% of samples were HPV DNA positive, respectively. There was substantial interassay agreements for the detection of all HPV genotypes (κ = 0.70, 86% agreement). Although LA was able to detect more genotypes per sample, the interassay agreement was acceptable (κ = 0.53, 63% agreement). GA had poorer specific detection of HPV genotypes 35, 42, and 51 (κ < 0.60). In conclusion, GA and LA showed good interassay agreement for the detection of most HPV genotypes in anal samples. However, the detection of HPV DNA in up to 76% of anal samples warrants further evaluation of its clinical significance. PMID:25502520

  10. Comparison of Hybribio GenoArray and Roche Human Papillomavirus (HPV) Linear Array for HPV Genotyping in Anal Swab Samples

    PubMed Central

    Silver, Michelle I.; Brown, Brandon J.; Leng, Chan Yoon; Blas, Magaly M.; Gravitt, Patti E.; Woo, Yin Ling

    2014-01-01

    Human papillomavirus (HPV) is causally associated with anal cancer, as HPV DNA is detected in up to 90% of anal intraepithelial neoplasias and anal cancers. With the gradual increase of anal cancer rates, there is a growing need to establish reliable and clinically relevant methods to detect anal cancer precursors. In resource-limited settings, HPV DNA detection is a potentially relevant tool for anal cancer screening. Here, we evaluated the performance of the Hybribio GenoArray (GA) for genotyping HPV in anal samples, against the reference standard Roche Linear Array (LA). Anal swab samples were obtained from sexually active men who have sex with men. Following DNA extraction, each sample was genotyped using GA and LA. The overall interassay agreement, type-specific, and single and multiple genotype agreements were evaluated by kappa statistics and McNemar's χ2 tests. Using GA and LA, 68% and 76% of samples were HPV DNA positive, respectively. There was substantial interassay agreements for the detection of all HPV genotypes (κ = 0.70, 86% agreement). Although LA was able to detect more genotypes per sample, the interassay agreement was acceptable (κ = 0.53, 63% agreement). GA had poorer specific detection of HPV genotypes 35, 42, and 51 (κ < 0.60). In conclusion, GA and LA showed good interassay agreement for the detection of most HPV genotypes in anal samples. However, the detection of HPV DNA in up to 76% of anal samples warrants further evaluation of its clinical significance. PMID:25502520

  11. Deposition of anal-sac secretions by captive wolves (Canis lupus)

    USGS Publications Warehouse

    Asa, C.S.; Peterson, E.K.; Seal, U.S.; Mech, L.D.

    1985-01-01

    Deposition of anal-sac secretions by captive wolves was investigated by a labelling technique using protein-bound iodine125 and food dye. Wolves deposited secretions on some but not all scats. Adult males, especially the alpha male, deposited anal-sac secretions more frequently while defecating than did females or juveniles. Secretions sometimes also were deposited independently of defecation, suggesting a dual role in communication by these substances.

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

    PubMed

    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. PMID:25887064

  13. Five-year cumulative incidence of invasive anal cancer among HIV-infected patients according to baseline anal cytology results: an inception cohort analysis

    PubMed Central

    Cachay, E.; Agmas, W.; Mathews, C.

    2015-01-01

    Objectives The aim of the study was to estimate the cumulative incidence of, and rates of progression to, invasive anal cancer (IAC) according to baseline anal cytology screening category in an unselected HIV clinical care cohort in the antiretroviral era. Methods A retrospective cohort analysis of HIV-infected patients under care at the University of California at San Diego Owen Clinic was carried out. Patients were eligible for this analysis if they had at least two anal cytohistological results available for longitudinal analysis. Kaplan-Meier analysis was used to estimate the cumulative incidence of IAC over time according to baseline cytology category [less than high-grade intraepithelial lesion (HSIL) versus HSIL]. Cox regression analysis was used to adjust for the following covariates: antiretroviral use, level of HIV viraemia, smoking status and infrared photocoagulation (IRC) ablation therapy. Results Between 2000 and 2012, we followed 2804 HIV-infected patients for a median of 4 years under a clinic protocol requiring baseline anal cytology screening. Incident IAC was diagnosed in 23 patients. Patients with a baseline HSIL anal cytology had an estimated 5-year probability of progression to IAC of 1.7% and an estimated annual progression risk of 1 in 263. None of the examined covariates was significantly associated with IAC incidence when examined in separate unadjusted Cox models. Conclusions HIV-infected patients with a baseline HSIL anal cytology had a 5-year cumulative incidence of IAC of 1.65%, with an upper 95% confidence bound of 4.5%. This population-based study provides quantitative risk estimates that may be used for counselling patients regarding management options for abnormal cytology results. PMID:25197003

  14. Successful Treatment of Metastatic Anal Canal Adenocarcinoma with mFOLFOX6 + Bevacizumab

    PubMed Central

    Matsunaga, Mototsugu; Miwa, Keisuke; Oka, Yosuke; Nagasu, Sachiko; Sakaue, Takahiko; Fukahori, Masaru; Ushijima, Tomoyuki; Akagi, Yoshito

    2016-01-01

    Anal canal adenocarcinoma is a relatively rare malignancy without established diagnostic and treatment criteria. Case reports of chemotherapy for anal canal adenocarcinoma with distant metastasis are limited, and there is no convincing evidence for treatment effectiveness. A 62-year-old man complained of difficulty in defecation, anal pain, and bleeding during bowel movement. He was diagnosed with moderately differentiated primary anal canal adenocarcinoma. A computed tomography scan revealed multiple metastases in the lung and liver. The patient was treated with abdominoperineal resection to control local tumor growth and then with chemotherapy consisting of mFOLFOX6 + bevacizumab. Because he had an activating KRAS mutation, anti-EGFR therapy was not considered. A reduction in the size of lung and liver metastases was observed after 4 courses of mFOLFOX6 + bevacizumab, and after 22 courses, maximum reduction in the metastatic lesions was achieved. The patient demonstrated tolerable levels of oxaliplatin-related peripheral neurotoxicity (grades 1–2) and was considered as having partial response to treatment. He is currently at the partial response state for 1 year. We plan to continue the treatment unless the patient develops progressive disease or intolerable adverse reactions. This case demonstrates that anal canal adenocarcinoma with distant metastases could be successfully treated with mFOLFOX6 + bevacizumab therapy according to the guidelines for rectal carcinoma. However, as anal canal carcinoma has multiple histological subtypes, it is important to establish subtype-specific treatment strategies.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2016-01-01

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

  17. Anal malignant proliferative trichilemmoma: report of a rare case with review of literature.

    PubMed

    Cui, Ang; Mei, Zubing; Cui, Long

    2015-01-01

    Trichilemmoma is a rare type of benign cutaneous neoplasm, which derives from outer sheath of hair follicle. It barely develops malignant progression and has rarely been reported in anal cancer. In this article, we report a case of a 73-year-old woman who presented to the outer-patient department with complaints of a ruptured and longstanding anal phyma. All the appearances were atypical. Blood routine examination showed that neutrophilic granulocyte percentage was elevated and suggest it was a simple inflammation response. No evidence of malignancy was detected upon the laboratory examinations. Then we performed an abscess incision drainage for the patient. A few days later, the biopsy pathological report suggested the specimen is a malignant proliferative trichilemmoma. We decided to perform a wide local excision instead of an extended radical operation in order to preserve anus. After the surgery, we chose not to give chemoradio-treatment for fear of side effects and complications. Careful follow-up indicates that peri-anal malignant proliferative trichilemmoma may have a good prognosis and our treatment is a good choice for the patients with this tumor. Because of the low occurrence rate of anal cancer, especially malignant trichilemmoma, any clinical manifestation and experience are valuable. On one hand, our case may help to take the consideration of the diagnosis of malignant trichilemmoma in case of longtime-suffered peri-anal mass, on the other hand it propose a different treatment method from other anal cancers for clinical doctors. PMID:26045866

  18. Anal malignant proliferative trichilemmoma: report of a rare case with review of literature

    PubMed Central

    Cui, Ang; Mei, Zubing; Cui, Long

    2015-01-01

    Trichilemmoma is a rare type of benign cutaneous neoplasm, which derives from outer sheath of hair follicle. It barely develops malignant progression and has rarely been reported in anal cancer. In this article, we report a case of a 73-year-old woman who presented to the outer-patient department with complaints of a ruptured and longstanding anal phyma. All the appearances were atypical. Blood routine examination showed that neutrophilic granulocyte percentage was elevated and suggest it was a simple inflammation response. No evidence of malignancy was detected upon the laboratory examinations. Then we performed an abscess incision drainage for the patient. A few days later, the biopsy pathological report suggested the specimen is a malignant proliferative trichilemmoma. We decided to perform a wide local excision instead of an extended radical operation in order to preserve anus. After the surgery, we chose not to give chemoradio-treatment for fear of side effects and complications. Careful follow-up indicates that peri-anal malignant proliferative trichilemmoma may have a good prognosis and our treatment is a good choice for the patients with this tumor. Because of the low occurrence rate of anal cancer, especially malignant trichilemmoma, any clinical manifestation and experience are valuable. On one hand, our case may help to take the consideration of the diagnosis of malignant trichilemmoma in case of longtime-suffered peri-anal mass, on the other hand it propose a different treatment method from other anal cancers for clinical doctors. PMID:26045866

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

    PubMed

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

    2014-09-01

    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 anal intraepithelial neoplasia (HGAIN), the precursor for ASCC, is present in about 30 % of HIV+ MSM, but neither the progression rate to ASCC nor the regression rate are known. The incidence rate of ASCC among HIV-infected people has risen in the first decade after cART became available, but appears to be plateauing recently. Anal cytology has poor sensitivity and specificity. High resolution anoscopy (HRA) is advocated by some as a screening tool in high-risk groups, but is cumbersome and time-consuming and it is unknown whether HRA followed by treatment of HGAIN prevents ASCC. More research is needed on progression and regression rates of HGAIN, on effective therapy of HGAIN, and on biomarkers that predict HGAIN or anal cancer. HPV vaccination and earlier start of cART may prevent most anal cancers in the long run. PMID:24990810

  20. An Electronic Daily Diary Study of Anal Intercourse in Drug-Using Women

    PubMed Central

    Fisher, Dennis G.; Laurenceau, Jean-Philippe; Fortenberry, J. Dennis

    2015-01-01

    Women (N = 138) with histories of illicit drug use were recruited into an electronic diary study that used Android smartphones for data collection. The diary was to be completed each day for 12 weeks using an “app” created in HTML5 and accessed over the Internet via smartphone. Data collection included information on sexual behaviors with up to 10 partners per day and contextual factors surrounding sexual behavior such as drug use before/after, type of sexual behavior (oral, vaginal, anal), and other activities such as using condoms for vaginal and anal intercourse and use of sexual lubricants. The sample was predominantly African American (58 %); 20 % Latina, 20 % White and 2 % reported as Other. Most women reported either less than a high school education (33 %) or having a high school diploma (33 %). The mean age was 39 years (SD = 11.78). Anal intercourse occurred on days when women also reported using illicit drugs, specifically methamphetamine and cocaine. Anal intercourse was not an isolated sexual activity, but took place on days when vaginal intercourse and giving and receiving oral sex also occurred along with illicit drug use. Anal intercourse also occurred on days when women reported they wanted sex. HIV prevention interventions must address the risks of anal intercourse for women, taking into account concurrent drug use and sexual pleasure that may reduce individual harm-reduction behaviors. PMID:25835461

  1. An Electronic Daily Diary Study of Anal Intercourse in Drug-Using Women.

    PubMed

    Reynolds, Grace L; Fisher, Dennis G; Laurenceau, Jean-Philippe; Fortenberry, J Dennis

    2015-12-01

    Women (N = 138) with histories of illicit drug use were recruited into an electronic diary study that used Android smartphones for data collection. The diary was to be completed each day for 12 weeks using an "app" created in HTML5 and accessed over the Internet via smartphone. Data collection included information on sexual behaviors with up to 10 partners per day and contextual factors surrounding sexual behavior such as drug use before/after, type of sexual behavior (oral, vaginal, anal), and other activities such as using condoms for vaginal and anal intercourse and use of sexual lubricants. The sample was predominantly African American (58 %); 20 % Latina, 20 % White and 2 % reported as Other. Most women reported either less than a high school education (33 %) or having a high school diploma (33 %). The mean age was 39 years (SD = 11.78). Anal intercourse occurred on days when women also reported using illicit drugs, specifically methamphetamine and cocaine. Anal intercourse was not an isolated sexual activity, but took place on days when vaginal intercourse and giving and receiving oral sex also occurred along with illicit drug use. Anal intercourse also occurred on days when women reported they wanted sex. HIV prevention interventions must address the risks of anal intercourse for women, taking into account concurrent drug use and sexual pleasure that may reduce individual harm-reduction behaviors. PMID:25835461

  2. Purse-string morphology of external anal sphincter revealed by novel imaging techniques

    PubMed Central

    Bhargava, Valmik; Sheean, Geoff; Ledgerwood, Melissa; Sinha, Shantanu

    2014-01-01

    The external anal sphincter (EAS) may be injured in 25–35% of women during the first and subsequent vaginal childbirths and is likely the most common cause of anal incontinence. Since its first description almost 300 years ago, the EAS was believed to be a circular or a “donut-shaped” structure. Using three-dimensional transperineal ultrasound imaging, MRI, diffusion tensor imaging, and muscle fiber tracking, we delineated various components of the EAS and their muscle fiber directions. These novel imaging techniques suggest “purse-string” morphology, with “EAS muscles” crossing contralaterally in the perineal body to the contralateral transverse perineal (TP) and bulbospongiosus (BS) muscles, thus attaching the EAS to the pubic rami. Spin-tag MRI demonstrated purse-string action of the EAS muscle. Electromyography of TP/BS and EAS muscles revealed their simultaneous contraction and relaxation. Lidocaine injection into the TP/BS muscle significantly reduced anal canal pressure. These studies support purse-string morphology of the EAS to constrict/close the anal canal opening. Our findings have implications for the effect of episiotomy on anal closure function and the currently used surgical technique (overlapping sphincteroplasty) for EAS reconstructive surgery to treat anal incontinence. PMID:24458022

  3. Human papillomavirus in anal squamous cell carcinoma: an angel rather than a devil?

    PubMed

    Ravenda, Paola Simona; Zampino, Maria Giulia; Fazio, Nicola; Barberis, Massimo; Bottiglieri, Luca; Chiocca, Susanna

    2015-01-01

    Anal cancer is a rare disease with an increasing incidence worldwide but, unfortunately, even today the scientific community still has a limited knowledge and limited options of treatment. More than 50% of patients with anal cancer presenting at diagnosis with locoregional disease have good chances of cure with chemoradiotherapy (CT-RT). However, once patients develop metastatic spread, the prognosis is very poor. Human papillomavirus (HPV) is present in more than 80% of anal cancers and while multiple etiologic connections between HPV infection and anal cancer have already been well elucidated, its prognostic and/or predictive role is currently under investigation, especially among immunocompetent patients affected by this disease. In a single-institutional set, we have retrospectively analysed clinical data of 50 consecutive cases homogeneously treated with CT-RT for stage I-III anal squamous cell carcinoma. We found that HPV-positive anal cancers had a statistically significant improved five-year disease-free survival (DFS) compared to HPV-negative group. These findings could be explained by an increased chemo/radiosensitivity of HPV-positive tumours. Further efforts should be directed towards a better understanding of HPV-related oncogenesis and towards designing novel tailored strategies for the management of this disease both in terms of prevention and treatment. PMID:25987898

  4. [The current place of abdomino-anal pull-through resection of the rectum in the modern rectal cancer surgery].

    PubMed

    Nechaĭ, I A

    2014-01-01

    It was discussed abdomino-anal resection of rectum with relegation of colon excess in anal canal in case of cancer. It was presented the data about state of colo-anal functions in patients after such operations. The reasons of unsatisfactory functional results are analyzed in the article. Also it was described the factors influencing on violation of tank, evacuation and obturator functions. PMID:24874224

  5. Anal adenocarcinoma complicating chronic Crohn’s disease

    PubMed Central

    Papaconstantinou, Ioannis; Mantzos, Dionysios S.; Kondi-Pafiti, Agathi; Koutroubakis, Ioannis E.

    2015-01-01

    Introduction Colorectal adenocarcinoma and Crohn’s disease are known to be associated entities. However, a carcinoma arising within a chronic perianal fistulous tract in a patient with Crohn’s disease is a rare complication. Presentation of case We present a case of a 40-year-old male patient with a long-standing perianal Crohn’s disease who developed an anal mucinous adenocarcinoma within the fistulous tracts. Discussion Although, Crohn’s disease and colorectal carcinoma association is well established, few cases have been reported where the cancer has originated within a perianal fistula. Constant mucosal regeneration occurring within a fistula seems to be the predominant pathogenetic mechanism, while immunosuppressants and anti-TNF agents may also contribute to the malignant transformation. Unfortunately, the lack of suspicion and the inadequate physical examination or colonoscopy due to exacerbation of the perianal symptoms could lead to delayed diagnosis; and thus, a poor prognosis. Conclusion Albeit a rare complication, clinicians should maintain a high degree of vigilance about the possible development of adenocarcinoma in patients with long-standing perianal Crohn’s disease. Thus, these patients should be kept under regular surveillance with examination under anaesthesia and biopsies or curettage of the tracts. PMID:25884608

  6. Rectal atresia and anal stenosis: the difference in the operative technique for these two distinct congenital anorectal malformations.

    PubMed

    Lane, V A; Wood, R J; Reck, C; Skerritt, C; Levitt, M A

    2016-04-01

    Rectal atresia and anal stenosis are rare forms of anorectal malformations. The aim of the definitive surgical repair in such cases is to preserve the anal canal, the dentate line, and the sphincter complex. We present a case of rectal atresia and anal stenosis to demonstrate the differences in the operative repair. The techniques described leave the anterior wall of the very distal anal canal untouched in both rectal stenosis and anal atresia; however, the dissection of the rectum differs. The atretic rectum in rectal atresia is mobilized and sutured to the anal canal circumferentially. In anal stenosis, the posterior rectum is mobilized in the form of rectal advancement, and the posterior 180° is anastomosed directly to the skin (as in a standard PSARP) with preservation of the anal canal as the anterior 180° of the final anoplasty. These patients have an excellent prognosis for bowel control and fecal continence, and therefore, complete mobilization and resection of the anal canal must be avoided. PMID:26902368

  7. Prevalence of and risk factors for anal human papillomavirus in men having sex with women: A cross–national study

    PubMed Central

    Nyitray, Alan G.; Smith, Dan’elle; Villa, Luisa; Lazcano-Ponce, Eduardo; Abrahamsen, Martha; Papenfuss, Mary; Giuliano, Anna R.

    2010-01-01

    Background While the primary cause of anal cancer is human papillomavirus (HPV) infection in the anal canal, little attention has been paid to the epidemiology of anal HPV in men having sex with women (MSW). Methods Anal canal exfoliated cells from 903 MSW in Brazil (São Paulo), Mexico (Cuernavaca) and the United States (Tampa) were tested for HPV DNA. Results HPV prevalence in the anal canal (12.0%) was similar in MSW in each city (P=0.77) while 7.0% had oncogenic types. Men in Tampa had a four–fold higher prevalence of HPV 16 than men in São Paulo or Cuernavaca (P<0.001). Duration of relationship with a primary sex partner and ever having oral or anal sex with a man was associated with any HPV type and any oncogenic type while lifetime number of female sex partners was associated with any HPV type. Conclusions Anal canal HPV is commonly found in MSW and the prevalence of HPV 16 may differ substantially by geography. Men with a larger number of female sex partners, in a sexual relationship of <1 year duration, and with a history of oral or anal sex with men were most likely to have an anal HPV infection. PMID:20367457

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

    PubMed Central

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

    2012-01-01

    Background. Anal cancer is caused by human papillomavirus (HPV), yet little is known about anal HPV infection among healthy young women. Methods. A total of 2017 sexually active women in the control arm of an HPV-16/18 vaccine trial had a single anal specimen collected by a clinician at the 4-year study visit. Samples were tested for HPV by SPF10 PCR/DEIA/LiPA25, version 1. Results. A total of 4% of women had HPV-16, 22% had oncogenic HPV, and 31% had any HPV detected in an anal specimen. The prevalence of anal HPV was higher among women who reported anal intercourse, compared with those who did not (43.4% vs 28.4%; P < .001). Among women who reported anal intercourse, cervical HPV (adjusted odds ratio [aOR], 5.3 [95% confidence interval {CI}, 3.4–8.2]), number of sex partners (aOR, 2.2 [95% CI, 1.1–4.6] for ≥4 partners), and number of anal intercourse partners (aOR, 1.9 [95% CI, 1.1–3.3] for ≥2 partners) were independent risk factors for anal HPV detection. Among women who reported no anal intercourse, cervical HPV (aOR, 4.7 [95% CI, 3.7–5.9]), number of sex partners (aOR, 2.4 [95% CI, 1.7–3.4] for ≥4 partners), and report of anal fissures (aOR, 2.3 [95% CI, 1.1–4.8]) were associated with an increased odds of anal HPV detection. Conclusion. Anal HPV is common among young women, even those who report no anal sex, and was associated with cervical HPV infection. Anal fissures in women who report never having had anal intercourse may facilitate HPV exposure. Clinical Trials Registration. NCT00128661. PMID:22850119

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

    SciTech Connect

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

    2008-05-01

    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.

  10. Reinnervation of Urethral and Anal Sphincters With Femoral Motor Nerve to Pudendal Nerve Transfer

    PubMed Central

    Ruggieri, Michael R.; Braverman, Alan S.; Bernal, Raymond M.; Lamarre, Neil S.; Brown, Justin M.; Barbe, Mary F.

    2012-01-01

    Aims Lower motor neuron damage to sacral roots or nerves can result in incontinence and a flaccid urinary bladder. We showed bladder reinnervation after transfer of coccygeal to sacral ventral roots, and genitofemoral nerves (L1, 2 origin) to pelvic nerves. This study assesses the feasibility of urethral and anal sphincter reinnervation using transfer of motor branches of the femoral nerve (L2–4 origin) to pudendal nerves (S1, 2 origin) that innervate the urethral and anal sphincters in a canine model. Methods Sacral ventral roots were selected by their ability to stimulate bladder, urethral sphincter, and anal sphincter contraction and transected. Bilaterally, branches of the femoral nerve, specifically, nervus saphenous pars muscularis [Evans HE. Miller’s anatomy of the dog. Philadelphia: W.B. Saunders; 1993], were transferred and end-to-end anastomosed to transected pudendal nerve branches in the perineum, then enclosed in unipolar nerve cuff electrodes with leads to implanted RF micro-stimulators. Results Nerve stimulation induced increased anal and urethral sphincter pressures in five of six transferred nerves. Retrograde neurotracing from the bladder, urethral sphincter, and anal sphincter using fluorogold, fast blue, and fluororuby, demonstrated urethral and anal sphincter labeled neurons in L2–4 cord segments (but not S1–3) in nerve transfer canines, consistent with rein-nervation by the transferred femoral nerve motor branches. Controls had labeled neurons only in S1–3 segments. Postmortem DiI and DiO labeling confirmed axonal regrowth across the nerve repair site. Conclusions These results show spinal cord reinnervation of urethral and anal sphincter targets after sacral ventral root transection and femoral nerve transfer (NT) to the denervated pudendal nerve. These surgical procedures may allow patients to regain continence. PMID:21953679

  11. Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I)

    PubMed Central

    Northover, J; Glynne-Jones, R; Sebag-Montefiore, D; James, R; Meadows, H; Wan, S; Jitlal, M; Ledermann, J

    2010-01-01

    Background: The first UKCCCR Anal Cancer Trial (1996) demonstrated the benefit of chemoradiation over radiotherapy (RT) alone for treating epidermoid anal cancer, and it became the standard treatment. Patients in this trial have now been followed up for a median of 13 years. Methods: A total of 577 patients were randomised to receive RT alone or combined modality therapy using 5-fluorouracil and mitomycin C. All patients were scheduled to receive 45 Gy by external beam irradiation. Patients who responded to treatment were recommended to have boost RT, with either an iridium implant or external beam irradiation. Data on relapse and deaths were obtained until October 2007. Results: Twelve years after treatment, for every 100 patients treated with chemoradiation, there are an expected 25.3 fewer patients with locoregional relapse (95% confidence interval (CI): 17.5–32.0 fewer) and 12.5 fewer anal cancer deaths (95% CI: 4.3–19.7 fewer), compared with 100 patients given RT alone. There was a 9.1% increase in non-anal cancer deaths in the first 5 years of chemoradiation (95% CI +3.6 to +14.6), which disappeared by 10 years. Conclusions: The clear benefit of chemoradiation outweighs an early excess risk of non-anal cancer deaths, and can still be seen 12 years after treatment. Only 11 patients suffered a locoregional relapse as a first event after 5 years, which may influence the choice of end points in future studies. PMID:20354531

  12. HPV and oral lesions: preventive possibilities, vaccines and early diagnosis of malignant lesions

    PubMed Central

    TESTI, D.; NARDONE, M.; MELONE, P.; CARDELLI, P.; OTTRIA, L.; ARCURI, C.

    2015-01-01

    SUMMARY The importance of HPV in world healthy is high, in fact high-risk HPV types contribute significantly to viral associated neoplasms. In this article we will analyze vary expression of HPV in oral cavity both benign and malignant, their prevalence and the importance in early diagnosis and prevention. The classical oral lesions associated with human papillomavirus are squamous cell papilloma, condyloma acuminatum, verruca vulgaris and focal epithelial hyperplasia. Overall, HPV types 2, 4, 6, 11, 13 and 32 have been associated with benign oral lesions while HPV types 16 and 18 have been associated with malignant lesions, especially in cancers of the tonsils and elsewhere in the oropharynx. Transmission of the virus can occur with direct contact, genital contact, anal and oral sex; latest studies suggest a salivary transmission and from mother to child during delivery. The number of lifetime sexual partners is an important risk factor for the development of HPV-positive head-neck cancer. Oral/oropharyngeal cancer etiologically associated with HPV having an increased survival and a better prognostic (85%–90% to five years). There is no cure for the virus. There are two commercially available prophylactic vaccines against HPV today: the bivalent (16 and 18) Cervarix® and the tetravalent (6, 11, 16 and 18) Gardasil® and new vaccine Gardasil 9 (6, 11, 16, 18, 31, 33, 45, 52, 58) was approved in the United States. To be effective, such vaccination should start before “sexual puberty”. The vaccine could be an important preventive strategy, in fact the scientific community is in agreement on hypothesis that blocking the contagion it may also limit the distance complications as the oropharyngeal cancer. PMID:27555904

  13. HPV and oral lesions: preventive possibilities, vaccines and early diagnosis of malignant lesions.

    PubMed

    Testi, D; Nardone, M; Melone, P; Cardelli, P; Ottria, L; Arcuri, C

    2015-01-01

    The importance of HPV in world healthy is high, in fact high-risk HPV types contribute significantly to viral associated neoplasms. In this article we will analyze vary expression of HPV in oral cavity both benign and malignant, their prevalence and the importance in early diagnosis and prevention. The classical oral lesions associated with human papillomavirus are squamous cell papilloma, condyloma acuminatum, verruca vulgaris and focal epithelial hyperplasia. Overall, HPV types 2, 4, 6, 11, 13 and 32 have been associated with benign oral lesions while HPV types 16 and 18 have been associated with malignant lesions, especially in cancers of the tonsils and elsewhere in the oropharynx. Transmission of the virus can occur with direct contact, genital contact, anal and oral sex; latest studies suggest a salivary transmission and from mother to child during delivery. The number of lifetime sexual partners is an important risk factor for the development of HPV-positive head-neck cancer. Oral/oropharyngeal cancer etiologically associated with HPV having an increased survival and a better prognostic (85%-90% to five years). There is no cure for the virus. There are two commercially available prophylactic vaccines against HPV today: the bivalent (16 and 18) Cervarix® and the tetravalent (6, 11, 16 and 18) Gardasil® and new vaccine Gardasil 9 (6, 11, 16, 18, 31, 33, 45, 52, 58) was approved in the United States. To be effective, such vaccination should start before "sexual puberty". The vaccine could be an important preventive strategy, in fact the scientific community is in agreement on hypothesis that blocking the contagion it may also limit the distance complications as the oropharyngeal cancer. PMID:27555904

  14. Squamous cell carcinoma of the anal canal treated with chemoradiotherapy in a patient with HIV.

    PubMed

    Sugimoto, Aya; Nakazuru, Shoichi; Sakakibara, Yuko; Nishio, Kumiko; Yamada, Takuya; Ishida, Hisashi; Yajima, Keishiro; Uehira, Tomoko; Mori, Kiyoshi; Mita, Eiji

    2016-01-01

    Since the introduction of combination antiretroviral therapy (ART), the life expectancy has increased for patients infected with human immunodeficiency virus (HIV). This has been associated with reductions in the incidences of some AIDS-defining malignancies, such as Kaposi sarcoma and non-Hodgkin lymphoma, but has coincided with an increased incidence of non-AIDS-defining malignancies, such as anal cancer. However, anal cancers are rare in patients with HIV in Japan. We report the case of an HIV-infected patient with anal cancer treated with chemoradiotherapy. A 37-year-old man receiving ART for HIV infection presented with a 1-month history of left inguinal lymphadenopathy and anal pain. Magnetic resonance imaging and computed tomography revealed a 56-mm mass, left inguinal lymphadenopathy, and left external iliac lymphadenopathy. The mass had infiltrated from the anal canal to the right levator ani and corpus spongiosum. Colonoscopy revealed a tumor with an ulcer in the anal canal. Histological examination of the tumor biopsy specimens confirmed the diagnosis of squamous cell carcinoma. The patient was diagnosed with anal cancer (T4N2M1 stage IV), and he received 5-fluorouracil (1000mg/m(2) on days 1-4 and 29-32) plus mitomycin C (10mg/m(2) on days 1 and 29) and concurrent radiotherapy (total dose, 59.4Gy in 33 fractions) along with ART. The treatment-related adverse events were grade 4 leukopenia and neutropenia, grade 3 thrombocytopenia, and grade 2 radiation dermatitis. Moreover, CD4 suppression was observed:the CD4 count decreased from 190 cells/μl before chemoradiotherapy to 138 cells/μl after 3 months, but increased to 210 cells/μl after 1 year. Because of the grade 4 leukopenia and neutropenia, the dose of 5-fluorouracil was reduced to 800mg/m(2) on days 29-32. A complete response was confirmed on magnetic resonance imaging, and colonoscopy confirmed the disappearance of the anal cancer. The patient is living with no signs of recurrence at 2 years

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

    PubMed Central

    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

    Background 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. Methods 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. Results 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. Conclusion 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. PMID:27548632

  16. Size of anal squamous cell carcinomas at diagnosis: a retrospective case series.

    PubMed

    Read, T R H; Huson, K L; Millar, J L; Haydon, A; Porter, I W T; Grulich, A E; Hocking, J S; Chen, M Y; Bradshaw, C S; Fairley, C K

    2013-11-01

    Anal squamous cell carcinoma is more common in HIV-positive homosexual men than in the general population and prognosis worsens with increasing tumour size. To identify opportunities for earlier diagnosis, we aimed to determine size and visibility of anal squamous cell carcinoma at diagnosis. We conducted a retrospective review of medical records between 1992 and 2010 from one hospital radiotherapy centre, a major centre for HIV care, in Melbourne, Australia. Of 128 cases of anal squamous cell carcinoma, 24 (19%) were in HIV-positive men. At diagnosis, half (52%) of the tumours were externally visible and mean estimated tumour size was 36 mm (29 mm in HIV-positive and 38 mm in HIV-negative patients; p = 0.04) and 114/121 (94%) tumours were 1 cm or larger. The most frequent symptoms were bleeding (43%) and pain (36%) and mean duration of symptoms was 22 weeks. This suggests most anal squamous cell carcinoma were visible or palpable for some time before diagnosis, meaning that screening high-risk groups by anal inspection and palpation is plausible. PMID:23970608

  17. Anal Cancer Screening in an Urban HIV Clinic: Provider Perceptions and Practice.

    PubMed

    Sowah, Leonard Anang; Buchwald, Ulrike K; Riedel, David J; Gilliam, Bruce L; Khambaty, Mariam; Fantry, Lori; Spencer, Derek E; Weaver, Jeffery; Taylor, Gregory; Skoglund, Mary; Amoroso, Anthony; Redfield, Robert R

    2015-01-01

    In this article, we sought to understand the perceptions and practice of providers on anal cancer screening in HIV-infected patients. Providers in an academic outpatient HIV practice were surveyed. Data were analyzed to determine the acceptability and perceptions of providers on anal Papanicolaou tests. Survey response rate was 55.3% (60.7% among male and 47.4% among female providers). One-third of the providers had received screening requests from patients. Female providers had higher self-rated comfort with anal Papanicolaou tests, with a mean score of 7.1 (95% confidence interval [CI] 4.7-9.5) compared to 3.6 (95% CI 1.5-5.7) for male providers, P = .02. Sixty-seven percent of male providers and 37.5% of female providers would like to refer their patients for screening rather than perform the test themselves. Only 54.2% of our providers have ever performed anal cytology examination. Our survey revealed that not all providers were comfortable performing anal cancer screening for their patients. PMID:26307210

  18. Properties of HPV-positive and HPV-negative anal carcinomas.

    PubMed

    Williams, G R; Lu, Q L; Love, S B; Talbot, I C; Northover, J M

    1996-12-01

    Evidence of human papillomavirus (HPV) can be found in up to 85 per cent of anal carcinomas. In the vulva, a discrete subset of HPV-positive carcinomas which show koilocytic morphology and distinct clinical features has recently been identified (warty carcinoma). The morphological and prognostic features of HPV-positive and HPV-negative anal carcinomas were compared in this study of the tumour distribution of HPV DNA. Vulval and anal neoplasia are similar in many ways and we have also looked to see if their similarity extends to 'warty' morphology in relation to HPV status. Thirty-five resection specimens of anal carcinoma were examined with biotin-labelled probes for HPV 6, 11, 16, and 18 DNA, using a non-isotopic in situ hybridization (ISH) technique. No tumour was found to contain HPV 6, 11, or 18. Twenty-four (72 per cent) showed positivity for HPV 16 DNA. Staining was homogeneous and independent of local squamous, basaloid, or ductal differentiation. The majority of tumours showed staining suggestive of episomal, non-productive HPV infection. HPV-positive tumours were more likely to occur in the anal canal than perianally and to show a mixed squamous and basaloid appearance. No difference between the two groups was found in patient age, presence of adjacent dysplasia, ductal differentiation, or prognosis. There was no correlation between condylomatous tumour morphology and HPV 16 DNA positivity; thus, a subset equivalent to vulval warty carcinoma could not be identified. PMID:9014857

  19. Persistent orocutaneous and anal fistulae induced by nicorandil: a case report

    PubMed Central

    2009-01-01

    Introduction Although nicorandil is prescribed widely, awareness of its potential to cause serious complications to the gastrointestinal tract mucosa is limited. Whilst nicorandil-induced oral and anal ulceration is well documented in the literature, nicorandil-induced fistulation is not. This is the first report in the literature of a single patient demonstrating simultaneous orocutaneous and anal fistulae during nicorandil therapy. Two separate cases of orocutaneous and anal fistulae associated nicorandil usage have previously been documented in specialist journals. Case presentation A 71-year-old Caucasian man presented with a 3-year history of concurrent orocutaneous and anal fistulae. He had been exposed to 30 mg twice-daily nicorandil therapy for 4 years. Both fistulae responded poorly to intensive and prolonged conventional treatment but healed promptly on reduction and eventual withdrawal of nicorandil therapy. Conclusion Management of resistant cases of orocutaneous and anal fistulae in patients on high-dose nicorandil therapy may be impossible without reduction or even withdrawal of nicorandil. PMID:19946537

  20. Anal heterosex among young people and implications for health promotion: a qualitative study in the UK

    PubMed Central

    Marston, C; Lewis, R

    2014-01-01

    Objective To explore expectations, experiences and circumstances of anal sex among young people. Design Qualitative, longitudinal study using individual and group interviews. Participants 130 men and women aged 16–18 from diverse social backgrounds. Setting 3 contrasting sites in England (London, a northern industrial city, rural southwest). Results Anal heterosex often appeared to be painful, risky and coercive, particularly for women. Interviewees frequently cited pornography as the ‘explanation’ for anal sex, yet their accounts revealed a complex context with availability of pornography being only one element. Other key elements included competition between men; the claim that ‘people must like it if they do it’ (made alongside the seemingly contradictory expectation that it will be painful for women); and, crucially, normalisation of coercion and ‘accidental’ penetration. It seemed that men were expected to persuade or coerce reluctant partners. Conclusions Young people's narratives normalised coercive, painful and unsafe anal heterosex. This study suggests an urgent need for harm reduction efforts targeting anal sex to help encourage discussion about mutuality and consent, reduce risky and painful techniques and challenge views that normalise coercion. PMID:25122073

  1. High resolution anoscopy may be useful in achieving reductions in anal cancer local disease failure rates.

    PubMed

    Goon, P; Morrison, V; Fearnhead, N; Davies, J; Wilson, C; Jephcott, C; Sterling, J; Crawford, R

    2015-05-01

    Anal cancer is uncommon, with an incidence rate of 0.5-1.0 per 100,000 of the population but incidence rates have been steadily increasing over the last 3 decades. Biological and epidemiological evidence have been mounting and demonstrate that anal cancer has many similarities to cervical cancer, especially in regard to its aetiology. High-resolution anoscopy (HRA) of the anal region – analogous to colposcopy of the cervix, is a technique that is not well-known in the medical and surgical fraternity. Evidence to support the use of HRA for detection and treatment in the surveillance of AIN exists and strongly suggests that it is beneficial, resulting in reduced rates of cancer progression. Pilot data from our study showed a local disease failure rate of 1.73 per 1000 patient-months compared with a published rate of 9.89 per 1000 patient-months. This demonstrates a 5.72-fold reduction in local disease failure rates of patients with T1-T3 tumours; the data therefore suggests that use of HRA for detection and treatment in surveillance of anal cancer patients will help prevent local regional relapse at the anal site. There is an urgent need for a large, randomised controlled clinical trial to definitively test this hypothesis. PMID:24373061

  2. Anal Intercourse among Young Heterosexuals in Three US STD Clinics

    PubMed Central

    Gorbach, Pamina M.; Manhart, Lisa E.; Hess, Kristen L.; Stoner, Bradley P.; Martin, David H.; Holmes, King K.

    2016-01-01

    Background To examine factors associated with heterosexual anal intercourse (AI). Methods Between 2001 and 2004, 890 heterosexual adults aged 18-26 attending public STD clinics in Seattle, New Orleans and St Louis were interviewed using CASI and tested for sexually transmitted infections (STI) Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, and genital herpes (HSV-2). Characteristics associated with AI were identified using logistic regression. Results Overall 289 (32%) reported ever having had AI, 201 (26.5%) reported AI with at least one of their last three partners and 17% reported AI with their last partner. Fewer females than males reported condom use at last AI (24% vs. 47%, p<0.001). Ever having AI was associated with sex on the same day as meeting a partner (AOR 3.5 [95% CI 1.94-6.15]), receiving money for sex (AOR 3.3 [1.40-7.75]), and >3 lifetime sex partners (AOR 2.2 [1.17-4.26]) among women, and sex on the same day as meeting a partner (AOR 2.0 [1.28-3.14]) and paying for sex (AOR 1.8 [1.00-3.15]) among men. AI with the last partner was associated with sex toy use (AOR 5.3 [2.35-12.0]) and having concurrent partners (AOR 2.3 [1.18-4.26]) among men, and with sex within a week of meeting (AOR 2.7 [1.21-5.83]), believing the partner was concurrent (AOR 2.6 [1.38-4.83]), and partnership duration >3 months (AOR 3.2 [1.03-10.1]) among women. Prevalent STI was not associated with AI. Conclusions Many young heterosexuals attending STD clinics reported AI, which was associated with other sexual risk behaviors, suggesting a confluence of risks for HIV infection. PMID:19265740

  3. IMRT treatment of anal cancer with a scrotal shield

    SciTech Connect

    Hood, Rodney C.; Wu, Q. Jackie; McMahon, Ryan; Czito, Brian; Willett, Christopher

    2012-01-01

    The risk of sterility in males undergoing radiotherapy in the pelvic region indicates the use of a shielding device, which offers protection to the testes for patients wishing to maintain fertility. The use of such devices in the realm of intensity-modulated radiotherapy (IMRT) in the pelvic region can pose many obstacles during simulation, treatment planning, and delivery of radiotherapy. This work focuses on the development and execution of an IMRT plan for the treatment of anal cancer using a scrotal shielding device on a clinical patient. An IMRT plan was developed using Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA), using a wide array of gantry angles as well as fixed jaw and fluence editing techniques. When possible, the entire target volume was encompassed by the treatment field. When the beam was incident on the scrotal shield, the jaw was fixed to avoid the device and the collimator rotation optimized to irradiate as much of the target as possible. This technique maximizes genital sparing and allows minimal irradiation of the gonads. When this fixed-jaw technique was found to compromise adequate coverage of the target, manual fluence editing techniques were used to avoid the shielding device. Special procedures for simulation, imaging, and treatment verification were also developed. In vivo dosimetry was used to verify and ensure acceptable dose to the gonads. The combination of these techniques resulted in a highly conformal plan that spares organs and risk and avoids the genitals as well as entrance of primary radiation onto the shielding device.

  4. Therapeutic management of anal eczema: an evidence-based review

    PubMed Central

    Havlickova, B; Weyandt, G H

    2014-01-01

    Aim To conduct a systematic review of treatments for anal eczema (AE). Methods We conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted. Results The evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients. Discussion Features of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today. Conclusion This review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared. PMID:24898365

  5. Genetics of canine anal furunculosis in the German shepherd dog.

    PubMed

    Massey, Jonathan; Short, Andrea D; Catchpole, Brian; House, Arthur; Day, Michael J; Lohi, Hannes; Ollier, William E R; Kennedy, Lorna J

    2014-05-01

    Canine anal furunculosis (AF) is characterised by ulceration and fistulation of perianal tissue and is a disease that particularly affects German shepherd dogs (GSDs). There are some similarities between AF and perianal Crohn's disease (CD) in man. An immune-mediated aetiopathogenesis for AF has been suggested due to tissue pathology, a major histocompatibility complex (MHC) association and clinical response to ciclosporin. Genome-wide association studies (GWAS) can be conducted in dogs with fewer markers and individuals than would be required in a human study. A discovery GWAS was performed on 21 affected and 25 control GSDs from the UK. No SNPs reached genome-wide significance levels at this stage. However, 127 nominally associated SNPs were genotyped in further 76 cases and 191 controls from the UK and Finland. Sequencing of these regions was undertaken to discover novel genetic variation. Association testing of these variants in the UK and Finnish cohorts revealed nine significantly associated SNPs, six of which cause non-synonymous changes in protein sequence. The ADAMTS16 and CTNND2 gene regions were most significantly associated with disease. Members of the butyrophilin protein family, important in intestinal inflammatory regulation, were also associated with disease, but their independence from the MHC region remains to be established. The CTNND2 gene region is also interesting as this locus was implicated in human ulcerative colitis and CD, albeit at a different candidate gene: DAP. We suggest that this represents a common association between inflammatory bowel disease-related conditions in both species and believe that future studies will strengthen this link. PMID:24626934

  6. Felching among men who engage in barebacking (unprotected anal sex).

    PubMed

    Klein, Hugh

    2012-04-01

    Felching (sucking or eating semen out of someone's anus) is a sexual behavior about which virtually nothing has been written in the scholarly literature, despite the fact that it appears to be a not-uncommon practice among certain subpopulations of men who have sex with men (MSM). This study examined three broad research questions: (1) How common is felching? (2) How does a desire for felching relate to other HIV risk practices and risk behavior preferences? (3) What factors are associated with the desire to engage in felching? The data were from a content analysis study of one of the largest Internet websites specifically targeting MSM looking for partners for unprotected sex. A total of 1,316 profiles on the site were analyzed and selected randomly based on users' ZIP codes. Felching was mentioned as a sought-after practice in approximately one-sixth of the men's profiles. Men who wanted to find felching partners were significantly more likely than those not searching for felching partners to seek other types of risky sex, including unprotected oral and unprotected anal sex, and various enhanced risk preferences (e.g., having sex while high, multiple-partner sex, unwillingness to withdraw the penis prior to internal ejaculation). Multivariate analysis revealed several factors that were related to an interest in identifying partners online for felching, including race/ethnicity, indifference to sex partners' HIV serostatus, several sensation-seeking measures (e.g., wanting "wild" or "uninhibited" sex, self-identification as a "bug chaser"), and eroticizing ejaculatory fluids. PMID:21573705

  7. mFOLFOX6 Chemotherapy after Resection of Anal Canal Mucinous Adenocarcinoma

    PubMed Central

    Matsunaga, Mototsugu; Miwa, Keisuke; Oka, Yosuke; Nagasu, Sachiko; Sakaue, Takahiko; Fukahori, Masaru; Ushijima, Tomoyuki; Akagi, Yoshito

    2016-01-01

    Because of their rarity, there are no clear guidelines for the treatment of anal carcinomas; such tumors are normally subjected to the same modalities as recommended for rectal cancer. We report a patient with anal canal mucinous adenocarcinoma, with metastases in the pararectal and right inguinal lymph nodes, who was treated with abdominoperineal resection followed by mFOLFOX6 chemotherapy for 6 months (12 cycles). The patient has remained recurrence-free thus far, approximately 2 years since the surgery. As the optimal treatments for anal carcinomas have not been fully elucidated, we present this case to highlight a possible course of action for such patients that appears to be effective and promising.

  8. Combined radical radiation therapy and chemotherapy for primary squamous cell carcinoma of the anal canal.

    PubMed

    Cummings, B J; Rider, W D; Harwood, A R; Keane, T J; Thomas, G M; Erlichman, C; Fine, S

    1982-03-01

    Radical radiation therapy (5000 rads in 20 fractions in 4 weeks) combined with iv mitomycin (10 mg/m2) and 5-FU (1000 mg/m2/24 hours for 4 days) was used to treat 13 patients with locally advanced but operable squamous cell carcinoma of the anal canal. All patients achieved local control and retained anal continence, and none developed metastases. The patients were followed from 4 to 34 months (median, 12). Severe acute gastrointestinal toxic effects were seen in three patients; the same patients had significant thrombocytopenia or leukopenia. Treatment with this combined program may allow conservative management of squamous cell carcinoma of the anal canal and should be considered as an alternative to abdominoperineal resection. PMID:6800654

  9. Bacteriological comparison of low anal fistula operated by ordinary methods and laser methods

    NASA Astrophysics Data System (ADS)

    Yang, Yuanrong; Xiong, Yigai

    1996-09-01

    Since 1989, 42 cases with low anal fistula were operated with laser and ordinary methods respectively. During the operation, secreted or charred tissues were extracted from the surface of the wound for bacteria culture. Experimental group (laser method): no bacteria were found in 24 cases operated by laser method. Control group (ordinary method): bacterial were found in 16 out of 18 cases operated by ordinary methods. The results of two different group showed that they had statistical difference for P < 0.001. So, CO2 laser is proved to be a definitely practical tool in surgical use for its bacteria killing power. While the anal fistula were operated by the laser, the neurotic carboatomic tissue can block blood vessel and prevent infection from spreading. The high temperature produced by the carboatomic action have enough ability to kill directly the bacteria living in the anal fistula.

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

    PubMed Central

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

    2016-01-01

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