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Sample records for anal canal cancer

  1. Surveillance of Anal Canal Cancers.

    PubMed

    Adams, Richard

    2017-01-01

    Anal squamous cell cancer is most frequently a locoregional disease that is amenable to curative therapy in a majority of fit patients. Complete response rates after chemoradiotherapy (CRT) are good, with up to 75% of patients with no evidence of relapse on surveillance. Relapse is most frequently locoregional and is often amendable to salvage surgery with curative intent. Effective surveillance attempts to improve outcomes by identifying recurrent or persistent disease early, managing both acute and late toxicities, and offering reassurance to patients. This article explores the rationale and evidence for surveillance programs after definitive CRT.

  2. 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

  3. Anal cancer

    MedlinePlus

    Cancer - anus; Squamous cell carcinoma - anal; HPV - anal cancer ... cancer and the human papillomavirus or HPV infection. HPV is a sexually transmitted virus that has been linked to other cancers as well. Other major risk factors include: HIV ...

  4. Pathology of Anal Cancer.

    PubMed

    Hoff, Paulo M; Coudry, Renata; Moniz, Camila Motta Venchiarutti

    2017-01-01

    Anal canal cancer is rather an uncommon disease but its incidence is increasing. Squamous cell carcinoma (SCC) is the most frequent primary anal neoplasm and can encompass a variety of morphologies. HPV infection has a key role in precancerous lesions and cancer development by the production of E6 and E7 oncoproteins. Anal squamous precancerous lesions are now classified according to the same criteria and terminology as their cervical counterparts. The p16 expression by immunohistochemistry is a surrogate marker for human papilloma virus (HPV). Many other tumor types can arise in the anal canal, including adenocarcinomas, neuroendocrine tumors, malignant melanomas, lymphomas and various types of mesenchymal tumors. For differential diagnosis, immunostaining markers such as CK5/6 and p63 can be used to distinguish SCC and CK7 for adenocarcinoma. Other classical panels can also be applied as in other locations. Currently, there are no biomarkers able to predict prognosis or response to treatment in clinical practice.

  5. Dose planning objectives in anal canal cancer IMRT: the TROG ANROTAT experience

    SciTech Connect

    Brown, Elizabeth; Cray, Alison; Haworth, Annette; Chander, Sarat; Lin, Robert; Subramanian, Brindha; Ng, Michael

    2015-06-15

    Intensity modulated radiotherapy (IMRT) is ideal for anal canal cancer (ACC), delivering high doses to irregular tumour volumes whilst minimising dose to surrounding normal tissues. Establishing achievable dose objectives is a challenge. The purpose of this paper was to utilise data collected in the Assessment of New Radiation Oncology Treatments and Technologies (ANROTAT) project to evaluate the feasibility of ACC IMRT dose planning objectives employed in the Australian situation. Ten Australian centres were randomly allocated three data sets from 15 non-identifiable computed tomography data sets representing a range of disease stages and gender. Each data set was planned by two different centres, producing 30 plans. All tumour and organ at risk (OAR) contours, prescription and dose constraint details were provided. Dose–volume histograms (DVHs) for each plan were analysed to evaluate the feasibility of dose planning objectives provided. All dose planning objectives for the bone marrow (BM) and femoral heads were achieved. Median planned doses exceeded one or more objectives for bowel, external genitalia and bladder. This reached statistical significance for bowel V30 (P = 0.04), V45 (P < 0.001), V50 (P < 0.001), external genitalia V20 (P < 0.001) and bladder V35 (P < 0.001), V40 (P = 0.01). Gender was found to be the only significant factor in the likelihood of achieving the bowel V50 (P = 0.03) and BM V30 constraints (P = 0.04). The dose planning objectives used in the ANROTAT project provide a good starting point for ACC IMRT planning. To facilitate clinical implementation, it is important to prioritise OAR objectives and recognise factors that affect the achievability of these objectives.

  6. MITHRA – multiparametric MR/CT image adapted brachytherapy (MR/CT-IABT) in anal canal cancer: a feasibility study

    PubMed Central

    Manfrida, Stefania; Barbaro, Brunella; Colangione, Maria Maddalena; Masiello, Valeria; Mattiucci, Gian Carlo; Placidi, Elisa; Autorino, Rosa; Gambacorta, Maria Antonietta; Chiesa, Silvia; Mantini, Giovanna; Kovács, György; Valentini, Vincenzo

    2015-01-01

    Purpose The aim of this study is to test a novel multiparametric imaging guided procedure for high-dose-rate brachytherapy in anal canal cancer, in order to evaluate the feasibility and safety. Material and methods For this analysis, we considered all consecutive patients who underwent magnetic resonance/computed tomography image adapted brachytherapy (MR/CT-IABT) treated from February 2012 to July 2014. To conduct this project, we formed a working group that established the procedure and identified the indicators and benchmarks to evaluate the feasibility and safety. We considered the procedure acceptable if 90% of the indicators were consistent with the benchmarks. Magnetic resonance imaging with contrast and diffusion weighted imaging were performed with an MRI-compatible dummy applicator in the anus to define the position of the clinical target volume disease and biological information. A pre-implantation treatment planning was created in order to get information on the optimal position of the needles. Afterwards, the patient underwent a simulation CT and the definite post-implantation treatment planning was created. Results We treated 11 patients (4 men and 7 women) with MR/CT-IABT and we performed a total of 13 procedures. The analysis of indicators for procedure evaluation showed that all indicators were in agreement with the benchmark. The dosimetric analysis resulted in a median of V200, V150, V100, V90, V85, respectively of 24.6%, 53.4%, 93.5%, 97.6%, and 98.7%. The median coverage index (CI) was 0.94, the median dose homogeneity index (DHI) was 0.43, the median dose non-uniformity ratio (DNR) resulted 0.56, the median overdose volume index (ODI) was 0.27. We observed no episodes of common severe acute toxicities. Conclusions Brachytherapy is a possible option in anal cancer radiotherapy to perform the boost to complete external beam radiotherapy (EBRT). Magnetic resonance can also have biological advantages compared to the US. Our results suggest that

  7. Conformal Therapy Improves the Therapeutic Index of Patients with Anal Canal Cancer Treated with Combined Chemotherapy and External Beam Radiotherapy

    SciTech Connect

    Vuong, Te . E-mail: te.vuong@muhc.mcgill.ca; Kopek, Neil; Ducruet, Thierry; Portelance, Lorraine; Faria, Sergio; Bahoric, Boris; Devic, Slobodan

    2007-04-01

    Purpose: To evaluate the clinical outcomes of three-dimensional conformal radiotherapy (3D-CRT) in patients with anal canal cancer, in terms of local control (LC), freedom from relapse (FFR), and overall survival (OS) rates, and to estimate long-term toxicity data. Methods and Materials: Sixty historical patients, treated with conventional radiation techniques (C-RT), were used as controls, and 62 consecutive patients were treated with 3D-CRT. Patients treated with 3D-CRT received 54 Gy in 30 fractions delivered continuously, compared with 45-58.9 Gy (median dose, 54 Gy) in a split course in patients treated with C-RT. Chemotherapy consisted of 5-fluorouracil with either mitomycin-C or cis-platinum given concurrently with radiation. Survival curves were performed using the Kaplan-Meier model, and the Cox proportional hazards model was used for multivariate analysis of risk factors. Results: No differences in stage and age distribution were observed between the two groups. Patients treated with 3D-CRT and C-RT had an actuarial 5-year LC rate of 85.1% and 61.1%, respectively (p = 0.0056); the FFR rate was 70.2% and 46.1% (p = 0.0166), and the OS rate was 80.7% and 53.9% (p = 0.0171). In multivariate analysis, factors of significance for LC were nodal (N) status (p < 0.001); for OS, 3D-CRT (p = 0.038), N status (p 0.011), and T status (p = 0.012); and for FFR, 3D-CRT (p = 0.024) and N status (p < 0.001). Conclusion: The use of 3D-CRT allows patients with anal canal cancer to complete radiation and chemotherapy without interruption for toxicity, with significant improvements in LC, FFR, and OS.

  8. Anal Cancer

    MedlinePlus

    ... Content ASCO Conquer Cancer Foundation Journal of Clinical Oncology Journal of Oncology Practice ASCO University Donate eNEWS SIGNUP f Cancer. ... of medical, surgical, radiation, gynecologic, and pediatric oncologists, oncology nurses, physician assistants, social workers, and patient advocates. ...

  9. Prospective Evaluation of Acute Toxicity and Quality of Life After IMRT and Concurrent Chemotherapy for Anal Canal and Perianal Cancer

    SciTech Connect

    Han, Kathy; Cummings, Bernard J.; Lindsay, Patricia; Skliarenko, Julia; Craig, Tim; Le, Lisa W.; Brierley, James; Wong, Rebecca; Dinniwell, Robert; Bayley, Andrew J.; Dawson, Laura A.; Ringash, Jolie; Krzyzanowska, Monika K.; Moore, Malcolm J.; Chen, Eric X.; Easson, Alexandra M.; Kassam, Zahra; Cho, Charles; Kim, John

    2014-11-01

    Purpose: A prospective cohort study was conducted to evaluate toxicity, quality of life (QOL), and clinical outcomes in patients treated with intensity modulated radiation therapy (IMRT) and concurrent chemotherapy for anal and perianal cancer. Methods and Materials: From June 2008 to November 2010, patients with anal or perianal cancer treated with IMRT were eligible. Radiation dose was 27 Gy in 15 fractions to 36 Gy in 20 fractions for elective targets and 45 Gy in 25 fractions to 63 Gy in 35 fractions for gross targets using standardized, institutional guidelines, with no planned treatment breaks. The chemotherapy regimen was 5-fluorouracil and mitomycin C. Toxicity was graded with the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3. QOL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR29 questionnaires. Correlations between dosimetric parameters and both physician-graded toxicities and patient-reported outcomes were evaluated by polyserial correlation. Results: Fifty-eight patients were enrolled. The median follow-up time was 34 months; the median age was 56 years; 52% of patients were female; and 19% were human immunodeficiency virus—positive. Stage I, II, III, and IV disease was found in 9%, 57%, 26%, and 9% of patients, respectively. Twenty-six patients (45%) required a treatment break because of acute toxicity, mainly dermatitis (23/26). Acute grade 3 + toxicities included skin 46%, hematologic 38%, gastrointestinal 9%, and genitourinary 0. The 2-year overall survival (OS), disease-free survival (DFS), colostomy-free survival (CFS), and cumulative locoregional failure (LRF) rates were 90%, 77%, 84%, and 16%, respectively. The global QOL/health status, skin, defecation, and pain scores were significantly worse at the end of treatment than at baseline, but they returned to baseline 3 months after treatment. Social functioning and appetite scores were

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

    PubMed Central

    Poggio, Juan Lucas

    2011-01-01

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

  11. HIV– positive anal cancer: an update for the clinician

    PubMed Central

    Dandapani, Savita V; Eaton, Michael; Pagnini, Paul G

    2010-01-01

    Anal cancer used to be a rare cancer traditionally associated with elderly women. There are approximately 5260 cases per year in the U.S. (1). The onslaught of the Human Immunodeficiency Virus (HIV) virus has led to a change in anal cancer demographics. Anal cancer is on the rise in the U.S and the number of anal cases documented has quadrupled in the past 20 yrs correlating with the rise of the HIV epidemic. The incidence of anal cancer is 40 to 80 fold higher in the HIV positive (HIV+) population when compared to the general population (2). With the advent of highly active antiretroviral therapy (HAART), HIV+ patients are living longer as less are progressing to AIDS. As a consequence non AIDS defining cancers such as anal cancer are on the rise. Factors implicated in the etiology of anal cancer in HIV+ patients include (Human papillomavirus) HPV virus status, sexual habits, and a history of smoking. HPV 16 and receptive anal intercourse (RAI) increase the risk of anal cancer by 33% over the general population. In the general population, the rate of anal cancer is approximately 0.9 cases per 100,000. In patients with a history of RAI, the rate approaches 35 cases per 100,000 which is equivalent to the prevalence of cervical cancer (3). Smokers are eight times more likely to develop anal cancer. There has been much discussion about tailoring treatment decisions in HIV+ patients with anal cancer. This review focuses on squamous cell carcinomas of the anal canal which comprise 80 to 90% of all anal cancers diagnosed and highlight key issues in the management of HIV+ anal cancer patients including recent clinical trials. PMID:22811803

  12. Anal Canal Carcinoma in a Child With Disorders of Sex Development.

    PubMed

    Watanabe, Toshihiko; Horikawa, Reiko; Masaki, Hidekazu; Yoshioka, Takako; Matsumoto, Kimikazu; Kanamori, Yutaka

    2016-07-01

    Squamous cell carcinoma of the anal canal in children is rare. To date, the etiology and outcome of this condition have been not fully understood. Here, we report an 11-year-old child with anal canal cancer who had concomitant disorders of sex development. Radiotherapy followed by salvage surgery achieved disease-free survival of 3 years. Since overexpression of cell cycle regulatory protein p16 was immunohistochemically evident in tumor tissue, human papillomavirus infection was considered as a causative factor in the carcinogenesis.

  13. SU-E-T-621: Planning Methodologies for Cancer of the Anal Canal: Comparing IMRT, Rapid Arc, and Pencil Beam Scanning Proton Beam

    SciTech Connect

    McGlade, J; Kassaee, A

    2015-06-15

    Purpose: To evaluate planning methods for anal canal cancer and compare the results of 9-field Intensity Modulated Radiotherapy (IMRT), Volumetric Modulated Arc Therapy (Varian, RapidArc), and Proton Pencil Beam Scanning (PBS). Methods: We generated plans with IMRT, RapidArc (RA) and PBS for twenty patients for both initial phase including nodes and cone down phase of treatment using Eclipe (Varian). We evaluated the advantage of each technique for each phase. RA plans used 2 to 4 arcs and various collimator orientations. PBS used two posterior oblique fields. We evaluated the plans comparing dose volume histogram (DVH), locations of hot spots, and PTV dose conformity. Results: Due to complex shape of target, for RA plans, multiple arcs (>2) are required to achieve optimal PTV conformity. When the PTV exceeds 15 cm in the superior-inferior direction, limitations of deliverability start to dominate. The PTV should be divided into a superior and an inferior structure. The optimization is performed with fixed jaws for each structure and collimator set to 90 degrees for the inferior PTV. Proton PBS plans show little advantage in small bowel sparing when treating the nodes. However, PBS plan reduces volumetric dose to the bladder at the cost of higher doses to the perineal skin. IMRT plans provide good target conformity, but they generate hot spots outside of the target volume. Conclusion: When using one planning technique for entire course of treatment, Multiple arc (>2) RA plans are better as compared to IMRT and PBS plans. When combining techniques, RA for the initial phase in combination with PBS for the cone down phase results in the most optimal plans.

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

    PubMed Central

    2014-01-01

    Anal canal carcinoma is a rare gastro-intestinal cancer. Radiochemotherapy is the recommended primary treatment for patients with non-metastatic carcinoma; surgery is generally reserved for persistent or recurrent disease. Follow-up and surveillance after primary treatment is paramount to classify patients in those with complete remission, persistent or progressive disease. Locally persistent disease represents a clinically significant problem and its management remains subject of some controversy. The aim of this systematic review is to summarise recommendations for the primary treatment of anal canal carcinoma, to focus on the optimal time to consider residual disease as genuine persistence to proceed with salvage treatment, and to discern how this analysis might inform future clinical trials in management in this class of patients. PMID:24472223

  15. Squamous-cell Carcinoma of the Anus and Anal Canal: An Analysis of 55 Cases

    PubMed Central

    Gabriel, W. B.

    1941-01-01

    The analysis is of 55 cases admitted into St. Mark's Hospital from 1922 to 1940. The incidence was 3.35% of all cases of cancer of the rectum, anal canal and anus admitted during this period. Sex distribution—27 males and 28 females. The average age (61.7 years) is higher than that of columnar-cell carcinoma of the rectum (57.4 years). Histology.—The cases have been graded into three grades of malignancy—low grade, medium grade, and high grade. Low grade squamous carcinoma is twice as frequent in men as in women, and generally originates at the anal margin. Medium grade squamous carcinoma is equally distributed between men and women; it may arise at the anus or in the anal canal. High grade squamous carcinoma is much more common in the female sex and is almost entirely limited to the anal canal. Quadrant affected—about one-third of the anal margin growths and one-half of the anal canal growths were situated anteriorly. Differential diagnosis from simple papilloma, simple ulcer, chronic inflammation, tuberculous ulcer, tuberculide, primary chancre, amœbic ulcer, basal-cell carcinoma, columnar-cell carcinoma. Biopsy and grading essential before treatment is decided upon. The results of treatment in the three grades of malignancy are described. The best results were obtained in the early low-grade cases treated by interstitial radium needling. In the medium and high grades only three five-year survivals can be reported and these followed excision of the rectum. The management of the inguinal glands is discussed and the importance of a very close post-operative supervision emphasized. Squamous carcinoma of the anal canal may cause lymphatic metastases in the superior hæmorrhoidal glands; there have been four such cases in this series. Diathermy perineal excision is indicated in these cases. ImagesFig. 1Fig. 2Fig. 3Fig. 5Fig. 6aFig. 6bFig. 7Fig. 1Fig. 2Fig. 3Fig. 4 PMID:19992316

  16. HDR brachytherapy for anal cancer

    PubMed Central

    Kovács, Gyoergy

    2014-01-01

    The challenge of treating anal cancer is to preserve the anal sphincter function while giving high doses to the tumor and sparing the organ at risk. For that reason there has been a shift from radical surgical treatment with colostomy to conservative treatment. Radiotherapy combined with chemotherapy has an important role in the treatment of anal cancer patients. New techniques as intensity modulated radiotherapy (IMRT) have shown reduced acute toxicity and high rates of local control in combination with chemotherapy compared to conventional 3-D radiotherapy. Not only external beam radio-chemotherapy treatment (EBRT) is an established method for primary treatment of anal cancer, brachytherapy (BT) is also an approved method. BT is well known for boost irradiation in combination with EBRT (+/– chemotherapy). Because of technical developments like modern image based 3D treatment planning and the possibility of intensity modulation in brachytherapy (IMBT), BT today has even more therapeutic potential than it had in the era of linear sources. The combination of external beam radiotherapy (EBRT) and BT allows the clinician to deliver higher doses to the tumor and to reduce dose to the normal issue. Improvements in local control and reductions in toxicity therefore become possible. Various BT techniques and their results are discussed in this work. PMID:24982770

  17. Anal Cancer Treatment

    MedlinePlus

    ... cancer that remains after treatment with external-beam radiation therapy. Patients who have had treatment that saves the sphincter ... cancer remains or comes back after treatment with radiation therapy and chemotherapy. ... options. Patients who have had treatment that saves the sphincter ...

  18. Stages of Anal Cancer

    MedlinePlus

    ... cancer that remains after treatment with external-beam radiation therapy. Patients who have had treatment that saves the sphincter ... cancer remains or comes back after treatment with radiation therapy and chemotherapy. ... options. Patients who have had treatment that saves the sphincter ...

  19. Hidrosadenoma of the anal canal: a case report with review of the literature.

    PubMed

    Vainer, B; Bille Brahe, N E; Horn, T

    2003-02-01

    Hidrosadenoma of the anal canal is an extremely rare tumour. Only nine cases with similar histologic structure have been described in the literature, most representing tumours resected from the anal or rectal mucosa. We present a case of anal hidrosadenoma with immunohistochemical staining features identifying it as a true sweat gland tumour.

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

    MedlinePlus

    ... and Treatment? Anal Cancer About 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 ...

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

    PubMed

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

    2012-06-01

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

  2. Prophylactic HPV vaccination and anal cancer.

    PubMed

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

    2016-06-02

    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.

  3. Mitomycin-C- or Cisplatin-Based Chemoradiotherapy for Anal Canal Carcinoma: Long-Term Results

    SciTech Connect

    Olivatto, Luis O.; Cabral, Vania; Rosa, Arthur; Bezerra, Marcos; Santarem, Erick; Fassizoli, Ana; Castro, Leonaldson; Simoes, Jose Humberto; Small, Isabele A.; Ferreira, Carlos Gil

    2011-02-01

    Purpose: To evaluate the long-term efficacy of concurrent radiotherapy with mitomycin-C (MMC)-based or cisplatin (CP)-based combinations in a cohort of patients with locally advanced anal canal carcinoma. Methods and Materials: Between 1988 and 2000, 179 patients with locally advanced anal canal carcinoma were treated at the Instituto Nacional de Cancer with two cycles of chemotherapy during Weeks 1 and 5 of radiotherapy. 5-Fluorouracil (750 mg/m{sup 2} 120-hour infusion or 1,000 mg/m{sup 2} 96-hour infusion) plus CP (100 mg/m{sup 2}) on the first day of each cycle or MMC (10-15 mg/m{sup 2}) on the first day of Cycle 1 was administered concurrent with radiotherapy (total dose, 55-59.4 Gy). Of the 179 patients, 60% were included from a randomized trial initiated at the Instituto Nacional de Cancer in 1991 that compared concurrent chemoradiotherapy with MMC vs. CP. Results: The median follow-up for the whole chemoradiotherapy group was 83 months. The median patient age was 58 years, 57% had Stage T3-T4 tumors, and 35% had N-positive disease. The 5-year cumulative colostomy rate was not significantly different between the CP group (22%) and MMC group (29%; p = .28). The actuarial 10-year overall survival and disease-free survival rate for the CP group was 54% and 49% and for the MMC group was 52% and 53%, respectively (p = .32 and p = .92, respectively). On multivariate analysis, male gender (p = .042) and advanced Stage T3-T4 disease (p <.0001) were statistically significant for worse disease-free survival. Stage T3-T4 (p = .039) and N+ (p = .039) disease remained independently significant for overall survival. Conclusion: Long-term follow-up has confirmed the good results of chemoradiotherapy with CP plus 5-fluorouracil, which seem to provide results equivalent to those with MMC plus 5-fluorouracil.

  4. Perianal and Vulvar Extramammary Paget Disease: A Report of Six Cases and Mapping Biopsy of the Anal Canal

    PubMed Central

    Kazama, Sinsuke; Yamada, Daisuke; Miyagawa, Takuya; Murono, Koji; Yasuda, Koji; Nishikawa, Takeshi; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Masui, Yuri; Nozawa, Hiroaki; Yamaguchi, Hironori; Ishihara, Soichiro; Kadono, Takafumi; Watanabe, Toshiaki

    2016-01-01

    Treatment of perianal and vulvar extramammary Paget disease (EMPD), rare intraepithelial malignancies, is often challenging because of its potential to spread into the anal canal. However, there is still no consensus regarding the optimal resection margin within the anal canal. Between 2004 and 2014, six patients (three with perianal EMPD and three with vulvar EMPD) in which the spread of Paget cells into the anal canal was highly suspected were referred to our department. To evaluate the disease extent within the anal canal, preoperative mapping biopsy of the anal canal was performed in five out of six patients. Two patients were positive for Paget cells within the anal canal (one at the dentate line and the other at 0.5 cm above the dentate line), whereas in three patients, Paget cell were present only in the skin of the anal verge. Using 1 cm margin within the anal canal from the positive biopsy sites, we performed anal-preserving wide local excision (WLE), and negative resection margins within the anal canal were confirmed in all five patients. The remaining one patient with perianal EMPD did not undergo mapping biopsy of the anal canal because preoperative colonoscopy revealed that the Paget cells had spread into the lower rectum. Therefore, WLE with abdominoperineal resection was performed. During the median follow-up period of 37.3 months, no local recurrence was observed in all patients. Our small case series suggest the usefulness of mapping biopsy of the anal canal for the treatment of perianal and vulvar EMPD. PMID:27746643

  5. Perianal and Vulvar Extramammary Paget Disease: A Report of Six Cases and Mapping Biopsy of the Anal Canal.

    PubMed

    Nagai, Yuzo; Kazama, Sinsuke; Yamada, Daisuke; Miyagawa, Takuya; Murono, Koji; Yasuda, Koji; Nishikawa, Takeshi; Tanaka, Toshiaki; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Masui, Yuri; Nozawa, Hiroaki; Yamaguchi, Hironori; Ishihara, Soichiro; Kadono, Takafumi; Watanabe, Toshiaki

    2016-10-01

    Treatment of perianal and vulvar extramammary Paget disease (EMPD), rare intraepithelial malignancies, is often challenging because of its potential to spread into the anal canal. However, there is still no consensus regarding the optimal resection margin within the anal canal. Between 2004 and 2014, six patients (three with perianal EMPD and three with vulvar EMPD) in which the spread of Paget cells into the anal canal was highly suspected were referred to our department. To evaluate the disease extent within the anal canal, preoperative mapping biopsy of the anal canal was performed in five out of six patients. Two patients were positive for Paget cells within the anal canal (one at the dentate line and the other at 0.5 cm above the dentate line), whereas in three patients, Paget cell were present only in the skin of the anal verge. Using 1 cm margin within the anal canal from the positive biopsy sites, we performed anal-preserving wide local excision (WLE), and negative resection margins within the anal canal were confirmed in all five patients. The remaining one patient with perianal EMPD did not undergo mapping biopsy of the anal canal because preoperative colonoscopy revealed that the Paget cells had spread into the lower rectum. Therefore, WLE with abdominoperineal resection was performed. During the median follow-up period of 37.3 months, no local recurrence was observed in all patients. Our small case series suggest the usefulness of mapping biopsy of the anal canal for the treatment of perianal and vulvar EMPD.

  6. How Is Anal Cancer Diagnosed?

    MedlinePlus

    ... This test can be used to see how deep the cancer has grown into the tissues surrounding ... Cancer Atlas Press Room Cancer Statistics Center Volunteer Learning Center Follow Us Twitter Facebook Instagram Cancer Information, ...

  7. Extrapulmonary Small Cell Carcinoma of the Anal Canal: A Case Report and Review of the Literature

    PubMed Central

    Eberhardt, Joshua M.; Brown, Karen; Lo, Shelly; Nagda, Suneel; Yong, Sherri

    2012-01-01

    Purpose. Extrapulmonary small cell carcinoma affecting the anal canal is a rare and poorly understood entity which can, in its early stages, masquerade as benign anorectal disease such as hemorrhoids. Methods. We report a case of this rare malignancy which initially presented with hematochezia and anal pain. We also review the literature with regard to previously described cases and management strategies including the role of surgery. Results. Despite aggressive multidisciplinary treatment consisting of chemotherapy and radiation, the disease progressed rapidly with dissemination occurring only three months after completion of treatment. Because of the aggressive nature of this tumor, the treatment options for this almost universally fatal malignancy are often palliative in nature. Conclusion. Chemoradiotherapy is likely the most reasonable approach to extrapulmonary small cell carcinoma of the anal canal given its aggressiveness. PMID:22454644

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

    SciTech Connect

    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.

  9. Diversity of human papillomavirus in the anal canal of men: The HIM study

    PubMed Central

    Sichero, Laura; Nyitray, Alan G.; Nunes, Emily Montosa; Nepal, Bal; Ferreira, Silvaneide; Sobrinho, João S.; Baggio, Maria Luiza; Galan, Lenice; Silva, Roberto C.; Lazcano-Ponce, Eduardo; Giuliano, Anna R.; Villa, Luisa L.

    2015-01-01

    Human papillomavirus (HPV) infections are associated with development of anogenital lesions in men. There are no reports describing the distribution of non-alpha HPV types in the anal canal of a sexually diverse men group. The HIM (HPV in Men) Study is a multicenter study of the natural history of HPV infection in Brazil, Mexico and USA. At baseline, 12% of anal canal specimens PCR HPV-positive were not typed by the Roche Linear Array and were considered unclassified. Our goal was characterizing HPVs among these unclassified specimens at baseline and assess associations with participant socio-demographic and behavioral characteristics. Unclassified HPVs were typed by sequencing amplified PGMY09/11 products or cloning of PGMY/GP+ nested amplicons followed by sequencing. Further analysis was conducted using FAP primers. Of men with unclassified HPV at the anal canal, most (89.1%) were men who have sex with women (MSW). Readable sequences were produced for 62.8% of unclassified specimens, of which 75.2% were characterized HPV types. A total of 18, 26, and 3 different α-, β- and γ-HPV types were detected, respectively. Compared to older men (45-70 years), α-HPVs were more commonly detected among young men (18-30 years) whereas β-HPVs were more frequent among mid-adult men (31-44 years). β-HPVs were more common among heterosexual men (85.0%) than non-heterosexual men. β2-HPV types composed all β-HPVs detected among non-heterosexual men. The high prevalence of β-HPV in the anal canal of men who do not report receptive anal sex is suggestive of other forms of transmission that do not involve penile-anal intercourse. PMID:25698660

  10. Treatment Option Overview (Anal Cancer)

    MedlinePlus

    ... cancer that remains after treatment with external-beam radiation therapy. Patients who have had treatment that saves the sphincter ... cancer remains or comes back after treatment with radiation therapy and chemotherapy. ... options. Patients who have had treatment that saves the sphincter ...

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

    SciTech Connect

    Sale, Charlotte; Moloney, Phillip; Mathlum, Maitham

    2013-12-15

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

  12. 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.

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

    PubMed

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

    2017-01-17

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

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

    PubMed Central

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

    2017-01-01

    Squamous cell carcinomas of the anus and anal canal represent a model of a cancer and perhaps the first where level 1 evidence supported primary chemoradiotherapy (CRT) in treating locoregional disease with curative intent. The majority of tumours are associated with infection with oncogenic subtypes of human papilloma virus and this plays a significant role in their sensitivity to treatment. However, not all tumours are cured with CRT and there remain opportunities to improve outcomes in terms of oncological control and also reducing late toxicities. Understanding the biology of ASCC promises to allow a more personalised approach to treatment, with the development and validation of a range of biomarkers and associated techniques that are the focus of this review. PMID:27923035

  15. Anal anatomy and normal histology.

    PubMed

    Pandey, Priti

    2012-12-01

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

  16. [Squamous carcinoma of the anal canal and its variations. Personal experience and review of the literature].

    PubMed

    Messinetti, S; Marzullo, A; Giacomelli, L; Manno, A; Pavone, M G; Fabrizio, G; Finizio, R; Porcelli, C; Granai, A V

    1994-01-01

    Six cases of anal canal squamous carcinoma are presented. The authors precise the present view about pathological, epidemiological, clinical and therapeutical aspects of these lesions. They stress, also, the primary role of embryology and anatomy in the oncogenesis of such tumours; the importance to single out specific population at risk, absolutely different from the typical one for rectal adenocarcinoma and the role of chemoradiation therapy as treatment of choice of these neoplasms. Particular importance is given to modern histologic and histogenetic classification of these tumours, stressing the difficulties to distinguish the various histologic types.

  17. Summary of emerging targets in anal cancer: the case for an immunotherapy based-approach

    PubMed Central

    Morris, Van

    2016-01-01

    Squamous cell carcinoma of the anal canal (SCCA) remains a less common gastrointestinal malignancy despite a continued increase in the annual incidence in the United States and globally. The vast majority of all cases are attributed to persistent infection and integration into host cell DNA by human papillomavirus (HPV). For patients with metastatic anal cancer, there is currently no accepted consensus standard of care. Given the viral etiology associated with the oncogenesis of this tumor, great interest exists for the development of immunotherapy as a novel approach to improving clinical outcomes for patients afflicted with this disease. This review highlights various immunotherapies under investigation in the treatment of advanced human malignancies and discusses their potential as future treatments for metastatic anal cancer. PMID:27747086

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

    SciTech Connect

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

    2014-10-01

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

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

    PubMed

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

    2014-01-01

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

  20. Extramammary Paget’s Disease of Anal Canal Associated With Rectal Adenoma Without Invasive Carcinoma

    PubMed Central

    Chumbalkar, Vaibhav; Jennings, Timothy A.; Ainechi, Sanaz; Lee, Edward C.; Lee, Hwajeong

    2016-01-01

    Extramammary Paget’s disease (EMPD) is a rare disease which is found in apocrine-rich locations such as anogenital region, axilla and rarely in other sites. Perianal EMPD is often reported as the involvement of perianal skin, but involvement of anal mucosa is very rare. Based on pathogenesis and association with either synchronous or metachronous malignancy, EMPD can be divided into primary and secondary types. Treatment approach for these two types of Paget’s disease and their prognosis is different, thus it is important to make the distinction. Secondary type of Paget’s disease is almost always described in association with invasive malignancy. While secondary Paget’s disease arising in association with ductal carcinoma in situ of the breast is common, secondary EMPD associated with precursor lesion of the rectum without invasion is exceedingly rare. We report a very rare case of secondary Paget’s disease of the anal canal in association with rectal tubular adenoma (precursor lesion) without malignancy. PMID:28058078

  1. Cancer incidence in the Love Canal area

    SciTech Connect

    Janerich, D.T.; Burnett, W.S.; Feck, G.; Hoff, M.; Nasca, P.; Polednak, A.P.; Greenwald, P.; Vianna, N.

    1981-06-01

    Data from the New York Cancer Registry show no evidence for higher cancer rates associated with residence near the Love Canal toxic waste burial site in comparison with the entire state outside of New York City. Rates of liver cancer, lymphoma, and leukemia, which were selected for special attention, were not consistently elevated. Among the other cancers studied, a higher rate was noted only for respiratory cancer, but it was not consistent across age groups and appeared to be related to a high rate for the entire city of Niagara Falls. There was no evidence that the lung cancer rate was associated with the toxic wastes buried at the dump site.

  2. Cancer incidence in the Love Canal area.

    PubMed

    Janerich, D T; Burnett, W S; Feck, G; Hoff, M; Nasca, P; Polednak, A P; Greenwald, P; Vianna, N

    1981-06-19

    Data from the New York Cancer Registry show no evidence for higher cancer rates associated with residence near the Love Canal toxic waste burial site in comparison with the entire state outside of New York City. Rates of liver cancer, lymphoma, and leukemia, which were selected for special attention, were not consistently elevated. Among the other cancers studied, a higher rate was noted only for respiratory cancer, but it was not consistent across age groups and appeared to be related to a high rate for the entire city of Niagara Falls. There was no evidence that the lung cancer rate was associated with the toxic wastes buried at the dump site.

  3. [Clinical to target volume margins determination in radiotherapy for anal cancers].

    PubMed

    Libois, V; Mahé, M-A; Rio, E; Maingon, P

    2016-10-01

    There are very few data on the expansion from the clinical target volume (CTV) to the planning target volume (PTV) in the anal cancer treatment. This article aims to collect the different elements needed for the construction of a PTV from scientific data based on a literature analysis. We reviewed the articles published in the medical literature from the last 20years. They concerned setup errors and internal organ mobility of the different volumes of patients treated by conformational radiotherapy and intensity-modulated radiotherapy (anal canal, meso-rectum, common, intern and extern, inguinal and pre-sacral lymph nodes). CTV to PTV margins admitted in the guidelines and atlas of consensus groups (SFRO, RTOG, AGITG) are from 0.7 to 1cm in all directions, based on expert's opinions but not on scientific data. There are no specific studies on the canal anal mobility. Most of the data are from other pelvis cancers (gynecologic, rectum and prostate). Setup errors can be reduced by daily imaging. Patient repositioning and immobilization modalities are mostly local habits rather than scientific consensus. A three-dimensional 1cm margin is generally admitted. Margins reduction must be careful and has to be assessed.

  4. [Adenocarcinoma of anal canal. Report of a case and review of the literature].

    PubMed

    Pollastri, E; Brosutti, O; Montenovo, A; Bergero, A; Moroni, J

    1994-01-01

    Carcinomas of the anal channel includes only 2 to 6 per cent of all colorectal tumors. They are squamous cell carcinomas, cloacogenic carcinoma and unusually, adenocarcinomas. A 41 year old man in which an adenocarcinoma of the anal channel developed within a chronic perianal fistula, is presented. A review of the literature about adenocarcinoma or the anus is made, and then the incidence, probable etiologies, biologic behavior, clinical features, diagnosis, differential diagnosis and treatment are enunciated. This rare tumor is associated with chronic inflammatory disease of the anal channel because of its etiology (fistula-in-ano, condyloma acuminata), because of cellular changes that are perpetuated by local immunologic blockade. We conclude that any chronic inflammatory disease must be treated early and adequately to avoid metaplastic and frank neoplastic changes. A deep and early biopsy of any benign lesion must be made if it does not respond to treatment, and a histopathologic exam of any tissue resected in orificial surgery must be performed. We suggest to use the classification of histological typing used by the W.H.O. and the staging of cancer by the U.I.C.C. and A.J.C.C. (1987).

  5. Interstitial curietherapy in the conservative treatment of anal and rectal cancers

    SciTech Connect

    Papillon, J.; Montbarbon, J.F.; Gerard, J.P.; Chassard, J.L.; Ardiet, J.M. )

    1989-12-01

    Conservative treatment has become a valid alternative to radical surgery in most cases of cancer of the anal canal and in selected cases of cancer of the low rectum. In this strategy interstitial curietherapy has an appreciable role to play. The results of a series of 369 patients followed more than 3 years indicate that implantation of Iridium-192 is effective not as sole treatment but as a booster dose 2 months after a course of external beam or intracavitary irradiation. The dose delivered did not exceed 20 to 30 Gy and the implantations were always performed in one plane using either a plastic template or a steel fork. Three groups of cases must be considered: (a) among 221 patients with epidermoid carcinoma of the anal canal, the rate of death related to treatment failures was 20% and among the patients cured more than 90% retained normal sphincter function. (b) In 90 patients with T1-T2 invasive adenocarcinoma of the rectum, Iridium-192 was carried out after four applications of contact X ray therapy. The rate of control was 84%. (c) In 62 elderly, poor risk patients with T2-T3 tumor of the low rectum initially suitable for an abdomino-perineal resection, a tentative extension of the field of conservation was made using a split-course protocol combining a short course of external beam irradiation at a dose of 30-35 Gy in 10 fractions over 12 days and an Iridium-192 implant. The rate of death due to treatment failures was 14.5% and among the patients controlled 97% had a normal anal function. These results show that implantations of Iridium-192 may contribute to the control of anal and rectal cancers and may spare many patients a permanent colostomy, but the treatment requires great care in patient selection, treatment protocol, technical details, and follow-up. This treatment policy must be conceived as a team work of radiation oncologists and surgeons.

  6. [A Case of Squamous Cell Carcinoma of the Anal Canal with a Perianal Abscess].

    PubMed

    Adikrisna, Rama; Udagawa, Masaru; Sugita, Yuusuke; Ishii, Takeshi; Okamoto, Hiroyuki; Yabata, Eiichi

    2015-11-01

    A 72-year-old female patient was referred to our department because she felt pain at the anus with pus discharge. Physical examination revealed a tumor on the left side of the anus, and a subcutaneous induration near the tumor. Abdominal CT scan revealed an irregularly shaped tumor with abscess formation. There were no enlarged lymph nodes or distant metastasis. Anal canal carcinoma (cStage Ⅱ) with a complication of perianal abscess was suspected, so we performed surgical incision and drainage. A biopsy of the tumor led to the diagnosis of squamous cell carcinoma. However, because surgical drainage alone was not effective for treatment of the abscess, colostomy of the sigmoid colon was carried out 14 days after admission. After chemoradiation therapy (5-FU 800 mg/m2/day on days 1-4 and 29-32, mitomycin C [MMC] 10 mg/m2 on days 1 and 29, and radiation with a total dose 54 Gy), the tumor disappeared completely, considered to be a complete response. Twenty months after chemoradiation, there were no signs of recurrence.

  7. Cancer Incidence among Former Love Canal Residents

    PubMed Central

    Gensburg, Lenore J.; Pantea, Cristian; Kielb, Christine; Fitzgerald, Edward; Stark, Alice; Kim, Nancy

    2009-01-01

    Background The Love Canal was a rectangular 16-acre, 10-ft-deep chemical waste landfill situated in a residential neighborhood in Niagara Falls, New York. This seriously contaminated site came to public attention in 1978. Only one prior study examined cancer incidence in former residents of the Love Canal neighborhood (LC). Objective In this study we aimed to describe cancer incidence in former LC residents from 1979 to 1996 and to investigate whether it differs from that of New York State (NYS) and Niagara County (NC). Methods From 1978 to 1982, we interviewed 6,181 former residents, and 5,052 were eligible to be included in this study. In 1996, we identified 304 cancer diagnoses in this cohort using the NYS Cancer Registry. We compared LC cancer incidence with that of NYS and NC using standardized incidence ratios (SIRs), and we compared risks within the LC group by potential exposure to the landfill using survival analysis. Results SIRs were elevated for cancers of the bladder [SIRNYS = 1.44; 95% confidence interval (CI), 0.91–2.16] and kidney (SIRNYS = 1.48; 95% CI, 0.76–2.58). Although CIs included 1.00, other studies have linked these cancers to chemicals similar to those found at Love Canal. We also found higher rates of bladder cancer among residents exposed as children, based on two cases. Conclusions In explaining these excess risks, the role of exposure to the landfill is unclear given such limitations as a relatively small and incomplete study cohort, imprecise exposure measurements, and the exclusion of cancers diagnosed before 1979. Given the relatively young age of the cohort, further surveillance is warranted. PMID:19672407

  8. 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

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

    PubMed

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

    2014-12-01

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

  10. Anal Cancer: What Happens After Treatment?

    MedlinePlus

    ... cancer survivors have learned to live with this uncertainty and are leading full lives. For other people, ... very stressful. It has its own type of uncertainty. Managing Cancer as a Chronic Illness covers more ...

  11. Do We Know What Causes Anal Cancer?

    MedlinePlus

    ... Employment Become a Supplier Report Fraud or Abuse Global Health ACS CAN Sign up for Email Policies Our Volunteers More ACS Sites Bookstore Shop Cancer Atlas Press Room Cancer Statistics Center Volunteer Learning Center Follow Us Twitter Facebook ...

  12. Enterobius vermicularis worm granuloma mimicking like a pseudo tumor in the anal canal: An unusual clinical presentation

    PubMed Central

    Bharathi, K; Anuradha, S; Chandrasekar, VC Ajay; Thirunarayanan, R

    2012-01-01

    Enterobius vermicularis is one of the most common intestinal nematode worldwide. Enterobius rarely causes a symptomatic disease. We report here an unusual case of a 60-year old man who came with a polypoidal growth in the anal canal increasing in size for past 20 years. He had pain and intense itching over the mass. The differential diagnosis of squamous papilloma, fibroma and foreign body granuloma were considered. The mass lesion was excised surgically and sent to the pathology laboratory. The mass turned out to be an “E. vermicularis worm granuloma” by histopathologic examination. Thus, timely reporting and surgical resection of such lesion is necessary to prevent further complications. This case is reported here for the unusual presentation of pinworm as a pseudoneoplasm in the anal canal. Incidence of these cases reflected the poor personal hygiene and improper disposal of human excreta in the rural areas. We insist that health education is the only way to control the spread of helminthic infections that causes a heavy disease burden to our country. PMID:23767020

  13. Dosimetric planning study for the prevention of anal complications after post-operative whole pelvic radiotherapy in cervical cancer patients with hemorrhoids

    PubMed Central

    Baek, J G; Kim, E C; Kim, S K

    2015-01-01

    Objective: Radiation-induced anal toxicity can be induced by low radiation doses in patients with haemorrhoids. The object of this study was to determine the dosimetric benefits of different whole pelvic radiotherapy (WPRT) techniques in terms of dose delivered to the anal canal in post-operative patients with cervical cancer. Methods: The planning CT images of 10 patients with cervical cancer undergoing postoperative radiotherapy were used for comparison of three different plans. All patients had been treated using the conventional box technique WPRT (CV-WPRT), and we tried low-margin-modified WPRT (LM-WPRT), three-dimensional conformal techniques WPRT (CF-WPRT) and intensity-modulated WPRT (IM-WPRT) planning for dosimetric comparison of the anal canal, retrospectively. Results: Mean anal canal doses of the IM-WPRT were significantly lower (p < 0.05) than those of CV-WPRT, LM-WPRT and CF-WPRT, and V10, V20, V30 and V40 to the anal canal were also significantly lower for IM-WPRT (p < 0.05). The proportion of planning target volumes (PTVs) that received ≥98% of the prescribed dose for all plans was >99%, and the proportion that received ≥108% of the prescribed dose for IM-WPRT was <2%. Volumes of bladders and rectums that received ≥30 or ≥40 Gy were significantly lower for IM-WPRT than for three of the four-field WPRT plans (p = 0.000). Conclusion: IM-WPRT can significantly reduce radiation dose delivered to the anal canal and does not compromise PTV coverage. In patients with haemorrhoids, IM-WPRT may be of value for the prevention of anal complications. Advances in knowledge: Although tolerance of the anal canal tends to be ignored in patients undergoing post-operative WPRT, patients with haemorrhoids may suffer complications at low radiation doses. The present study shows IM-WPRT can be meaningful in these patients. PMID:26395671

  14. Anal Canal Adenocarcinoma in a Patient with Longstanding Crohn’s Disease Arising From Rectal Mucosa that Migrated From a Previously Treated Rectovaginal Fistula

    PubMed Central

    Maejima, Taku; Kono, Toru; Orii, Fumika; Maemoto, Atsuo; Furukawa, Shigeru; Liming, Wang; Kasai, Shoji; Fukahori, Susumu; Mukai, Nobutaka; Yoshikawa, Daitaro; Karasaki, Hidenori; Saito, Hiroya; Nagashima, Kazuo

    2016-01-01

    Patient: Female, 50 Final Diagnosis: Anal canal adenocarcinoma Symptoms: — Medication: — Clinical Procedure: CT • MRI • biopsy Specialty: Surgery Objective: Unknown ethiology Background: This study reports the pathogenesis of anal canal adenocarcinoma in a patient with longstanding Crohn’s disease (CD). Case Report: A 50-year-old woman with a 33-year history of CD presented with perianal pain of several months’ duration. She had been treated surgically for a rectovaginal fistula 26 years earlier and had been treated with infliximab (IFX) for the previous 4 years. A biopsy under anesthesia revealed an anal canal adenocarcinoma, which was removed by abdominoperineal resection. Pathological examination showed that a large part of the tumor consisted of mucinous adenocarcinoma at the same location as the rectovaginal fistula had been removed 26 years earlier. There was no evidence of recurrent rectovaginal fistula, but thick fibers surrounded the tumor, likely representing part of the previous rectovaginal fistula. Immunohistochemical analysis using antibodies against cytokeratins (CK20 and CK7) revealed that the adenocarcinoma arose from the rectal mucosa, not the anal glands. Conclusions: Mucinous adenocarcinoma can arise in patients with CD, even in the absence of longstanding perianal disease, and may be associated with adenomatous transformation of the epithelial lining in a former fistula tract. PMID:27373845

  15. Positron Emission Tomography/Computed Tomography in the Staging and Treatment of Anal Cancer

    SciTech Connect

    Sveistrup, Joen; Loft, Annika; Berthelsen, Anne Kiil; Henriksen, Birthe Merete; Nielsen, Michael Bachmann; Engelholm, Svend Aage

    2012-05-01

    Purpose: This study was intended to determine the role of PET/CT in the staging of anal cancer as a supplement to three-dimensional transanal ultrasound (TAUS) and inguinal ultrasound (US). The impact of the PET/CT on the initial stage and treatment plan proposed by TAUS/US was assessed. Methods and Materials: Ninety-five (95) patients referred to our clinic between July 1, 2005, and December 31, 2009, were retrospectively reviewed. All patients had biopsy-proven primary squamous cell cancer of the anal canal. There were 65 females (68%) and 30 males (32%), and the median age was 58 years (range, 35-88 years). Six (6%) of the patients were HIV positive. All patients were staged with TAUS/US and PET/CT. Results: Twenty-eight (28) patients were diagnosed with suspicious perirectal node metastases. TAUS visualized 24 of these, whereas PET/CT detected 15. Suspicious inguinal nodes were visualized on either US or PET/CT in 41 patients. Seventeen (17) of these had confirmed malignant disease on biopsy, and 15 had confirmed benign disease. All 17 patients (100%) with malignant inguinal nodes were diagnosed by PET/CT, whereas US identified 16 (94%). Ten patients were diagnosed with suspicious inguinal nodes on PET/CT that had not been seen on US. One of these was malignant, three were benign, and six were not biopsied. PET/CT diagnosed eight metastatic sites, whereas TAUS/US diagnosed three. PET/CT discovered three of the five synchronous cancers seen in this study. PET/CT upstaged the disease in 14% of the cases and changed the treatment plan proposed by TAUS/US in 17%. Conclusion: PET/CT has great potential influence on the staging and treatment of anal cancer. TAUS is important in the staging of the primary tumor and N1-stage, whereas PET/CT seems necessary for the N2/3-stage, the M-stage and synchronous cancers.

  16. 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.

  17. What Are the Risk Factors for Anal Cancer?

    MedlinePlus

    ... uncircumcised male. For more information about HPV and HPV vaccines, see HPV Vaccines . Anal warts Anal warts (also known as condyloma acuminata ) are caused by infection with certain types of HPV – usually different types from those most likely to ...

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

    PubMed

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

    2014-07-01

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

  19. A case of metastatic carcinoma of anal fistula caused by implantation from rectal cancer.

    PubMed

    Takahashi, Rina; Ichikawa, Ryosuke; Ito, Singo; Mizukoshi, Kosuke; Ishiyama, Shun; Sgimoto, Kiichi; Kojima, Yutaka; Goto, Michitoshi; Tomiki, Yuichi; Yao, Takashi; Sakamoto, Kazuhiro

    2015-12-01

    This case involved an 80-year-old man who was seen for melena. Further testing revealed a tubular adenocarcinoma 50 mm in size in the rectum. In addition, an anal fistula was noted behind the anus along with induration. A biopsy of tissue from the external (secondary) opening of the fistula also revealed adenocarcinoma. Nodules suspected of being metastases were noted in both lung fields. The patient was diagnosed with rectal cancer, a cancer arising from an anal fistula, and a metastatic pulmonary tumor, and neoadjuvant chemotherapy was begun. A laparoscopic abdominoperineal resection was performed 34 days after 6 cycles of mFOLFOX-6 therapy. Based on pathology, the rectal cancer was diagnosed as moderately differentiated adenocarcinoma, and this adenocarcinoma had lymph node metastasis (yp T3N2aM1b). There was no communication between the rectal lesion and the anal fistula, and a moderately differentiated tubular adenocarcinoma resembling the rectal lesion was noted in the anal fistula. Immunohistochemical staining indicated that both the rectal lesion and anal fistula were cytokeratin 7 (CK7) (-) and cytokeratin 20 (CK20) (+), and the patient's condition was diagnosed as implantation of rectal cancer in an anal fistula.In instances where an anal fistula develops in colon cancer, cancer implantation in that fistula must also be taken into account, and further testing should be performed prior to surgery.

  20. Intensity-modulated radiation therapy (IMRT) in the treatment of anal cancer: Toxicity and clinical outcome

    SciTech Connect

    Milano, Michael T.; Jani, Ashesh B.; Farrey, Karl J.; Rash, Carla C.; Heimann, Ruth; Chmura, Steven J. . E-mail: schmura@radonc.uchicago.edu

    2005-10-01

    Purpose: To assess survival, local control, and toxicity of intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the anal canal. Methods and Materials: Seventeen patients were treated with nine-field IMRT plans. Thirteen received concurrent 5-fluorouracil and mitomycin C, whereas 1 patient received 5-fluorouracil alone. Seven patients were planned with three-dimensional anteroposterior/posterior-anterior (AP/PA) fields for dosimetric comparison to IMRT. Results: Compared with AP/PA, IMRT reduced the mean and threshold doses to small bowel, bladder, and genitalia. Treatment was well tolerated, with no Grade {>=}3 acute nonhematologic toxicity. There were no treatment breaks attributable to gastrointestinal or skin toxicity. Of patients who received mitomycin C, 38% experienced Grade 4 hematologic toxicity. IMRT did not afford bone marrow sparing, possibly resulting from the clinical decision to prescribe 45 Gy to the whole pelvis in most patients, vs. the Radiation Therapy Oncology Group-recommended 30.6 Gy whole pelvic dose. Three of 17 patients, who did not achieve a complete response, proceeded to an abdominoperineal resection and colostomy. At a median follow-up of 20.3 months, there were no other local failures. Two-year overall survival, disease-free survival, and colostomy-free survival are: 91%, 65%, and 82% respectively. Conclusions: In this hypothesis-generating analysis, the acute toxicity and clinical outcome with IMRT in the treatment of anal cancer is encouraging. Compared with historical controls, local control is not compromised despite efforts to increase conformality and reduce normal structure dose.

  1. Canals

    ERIC Educational Resources Information Center

    Winkleman, Michael

    1974-01-01

    In the mid-1800's, the canal system in the U.S. was thriving. But, by the end of that century, roads and railways had replaced these commercial thoroughfares. Renewed interest in the abandoned canals is now resulting in renovation and ecological site development in Pennsylvania and New Jersey. (MA)

  2. Replacing 5-fluorouracil by capecitabine in localised squamous cell carcinoma of the anal canal: systematic review and meta-analysis

    PubMed Central

    Souza, Karla T; Pereira, Allan AL; Araujo, Raphael L; Oliveira, Suilane Coelho Ribeiro; Hoff, Paulo M; Riechelmann, Rachel P

    2016-01-01

    Background The standard treatment for localised squamous cell carcinoma of the anal canal (SCCAC) is chemoradiotherapy (CRT) with infusional 5-fluorouracil (5-FU) and mitomycin. Because 5-FU and capecitabine have offered similar efficacy in many phase-III trials of solid tumours, studies have tested capecitabine in this setting of SCCAC. However, these studies are small and have reported variable results. Therefore, a systematic review and meta-analysis was performed. Methods Medline, Scopus and Embase were searched for studies that evaluated the efficacy outcomes of capecitabine used as a substitute of 5-FU in the CRT of localised SCCAC. The primary endpoint was complete response rate (CRR) at 6 months. Metaprop analysis of reported CRR-based on pooled estimates of proportions with corresponding 95% confidence intervals (95%CI) were calculated on the base of the Freeman-Tukey double arcsine transformation. Results We retrieved 300 studies, of which six met our eligibility criteria. The capecitabine dose ranged from 500 mg/m2 to 825 mg/m2 BID for 5 days per week during radiation. With a total of 218 patients, the median follow-up was 21.5 months (14–23). The pooled analysis of three trials (N = 132 patients) reported a CRR at 6 months of 88% (83%–94%), considering all clinical stages. The pooled analysis of overall CRR (N = 218 patients), evaluated at different intervals, showed an overall CRR of 91% (87%–95%). Rates of locoregional relapse varied from 3.2% to 21%. The majority of patients completed the planned radiotherapy dose (93.5%–100%) and any chemotherapy interruption was reported in up to 55.8% of patients. Conclusions Capecitabine is an acceptable and more convenient alternative to infusional 5-FU in the CRT for localised SCCAC, offering similar clinical CRR to those reported by phase-III trials. PMID:28105070

  3. Anal Canal Adenocarcinoma in a Patient with Longstanding Crohn's Disease Arising From Rectal Mucosa that Migrated From a Previously Treated Rectovaginal Fistula.

    PubMed

    Maejima, Taku; Kono, Toru; Orii, Fumika; Maemoto, Atsuo; Furukawa, Shigeru; Liming, Wang; Kasai, Shoji; Fukahori, Susumu; Mukai, Nobutaka; Yoshikawa, Daitaro; Karasaki, Hidenori; Saito, Hiroya; Nagashima, Kazuo

    2016-07-04

    BACKGROUND This study reports the pathogenesis of anal canal adenocarcinoma in a patient with longstanding Crohn's disease (CD). CASE REPORT A 50-year-old woman with a 33-year history of CD presented with perianal pain of several months' duration. She had been treated surgically for a rectovaginal fistula 26 years earlier and had been treated with infliximab (IFX) for the previous 4 years. A biopsy under anesthesia revealed an anal canal adenocarcinoma, which was removed by abdominoperineal resection. Pathological examination showed that a large part of the tumor consisted of mucinous adenocarcinoma at the same location as the rectovaginal fistula had been removed 26 years earlier. There was no evidence of recurrent rectovaginal fistula, but thick fibers surrounded the tumor, likely representing part of the previous rectovaginal fistula. Immunohistochemical analysis using antibodies against cytokeratins (CK20 and CK7) revealed that the adenocarcinoma arose from the rectal mucosa, not the anal glands. CONCLUSIONS Mucinous adenocarcinoma can arise in patients with CD, even in the absence of longstanding perianal disease, and may be associated with adenomatous transformation of the epithelial lining in a former fistula tract.

  4. 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.

  5. 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

  6. Human Papillomavirus Positivity in the Anal Canal in HIV-Infected and HIV-Uninfected Men Who Have Anal Sex with Men in Guangzhou, China: Implication for Anal Exams and Early Vaccination

    PubMed Central

    Ren, Xuqi; Ke, Wujian; Yang, Ligang; Huang, Shujie; Qin, Xiaolin

    2017-01-01

    Background. The epidemiology of HPV in men who have sex with men (MSM) in Guangzhou, China, had not been reported previously. Methods. HIV-infected and HIV-uninfected MSM were recruited from a Guangzhou-based MSM clinic in 2013. Sociodemographic characteristics and sexual behaviors were collected. An anal cytological sample was taken for HPV testing. Results. We recruited 79 HIV-infected and 85 HIV-uninfected MSM. The median age was 26 years in both groups. The positivities of anal HPV of any type (81.0% versus 48.2%), any high risk type (50.6% versus 27.1%), any low risk type (55.7% versus 31.8%), and any 9-valent vaccine type (74.7% versus 36.5%) were all significantly higher among HIV-infected compared to that among HIV-negative MSM (p for all < 0.05). The great majority of HPV-infected MSM were infected with 9-valent vaccine types (59 out of 64 HIV-infected and 31 out of 41 HIV-uninfected). Anal bacterial infections were associated with higher anal HPV positivity and greater number of anal HPV types. Conclusion. Sexually active MSM in Guangzhou, especially those infected with HIV, had high and multiple HPV detections. The majority of these cases were potentially preventable by HPV vaccine. Regular anal exams and early HPV vaccination are warranted in this population. PMID:28133605

  7. [A case report of metastatic anal fistula cancer treated with neoadjuvant chemotherapy].

    PubMed

    Murata, Akihiro; Takatsuka, Satoshi; Shinkawa, Hiroji; Kaizaki, Ryoji; Hori, Takaaki; Ikehara, Teruyuki

    2014-11-01

    A 69-year-old man with perianal pain was diagnosed with an anal fistula and a rectal tumor by magnetic resonance imaging and pulmonary tuberculosis by computed tomography. A colonoscopy confirmed the presence of a circular mass in the rectum 6 cm from the anal verge. Histological examination revealed a moderately differentiated adenocarcinoma. Initially, seton drainage was used to improve the perianal pain. After 2 months of anti-tuberculosis therapy, the patient underwent low anterior resection for the rectal cancer. Six months after surgery, a perianal tumor was detected at the postoperative site of the anal fistula. Biopsy of the tumor revealed adenocarcinoma. Because the histological appearance of the second tumor was identical to the rectal cancer, it was diagnosed as a metastatic anal fistula cancer. The tumor shrunk after 3 courses of neoadjuvant chemotherapy with S-1 plus oxaliplatin (SOX) plus bevacizumab and there was no evidence of distant metastasis. Local resection of the anal fistula cancer was performed. Six months postoperatively, the patient is doing well and shows no sign of recurrence.

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

    PubMed

    del Amo, Julia; González, Cristina; Geskus, Ronald B; Torres, Montse; Del Romero, Jorge; Viciana, Pompeyo; Masiá, Mar; Blanco, Jose R; Hernández-Novoa, Beatriz; Ortiz, Marta

    2013-04-15

    We estimated the effect of sexual behavior, age, and immunodeficiency on the number of high-risk human papillomavirus (HR-HPV) types in the anal canal among human immunodeficiency virus-positive men who have sex with men (MSM). Anal samples were genotyped with the Linear Array HPV Genotyping Test, and risk factors were investigated with Poisson regression. Of 586 MSM, 69% were Spanish, and 25.6% were Latin American; the median age was 34.9 years (interquartile range [IQR], 30.1-40.8). The median number of recent sex partners was 6 (IQR, 2-24 sex partners), and the median CD4(+) T-cell count was 531.5 cells/mm(3) (IQR, 403-701 cells/mm(3)). The prevalence of any and multiple HR-HPV infections was 83.4% and 60.5%, respectively. The most common types were HPV-16 (42%), HPV-51 (24%), HPV-39 (23.7%), and HPV-59 (23.5%). Age had a statistically significant, nonlinear association with the number of types, with the highest number detected around 35 years of age (P < .001). The number of recent sex partners had a statistically significant, fairly linear association on the log scale (P = .033). The high prevalence of HR-HPV types is associated with recent sexual behavior and age.

  9. Salvage abdominoperineal resection and perineal wound healing in local recurrent or persistent anal cancer.

    PubMed

    Ferenschild, Floris T J; Vermaas, Maarten; Hofer, Stefan O; Verhoef, Cornelis; Eggermont, Alexander M M; de Wilt, Johannes H W

    2005-11-01

    The primary treatment for anal cancer is chemoradiation (CRT). Failures after CRT are potentially curable with an abdominoperineal resection (APR). A major problem of surgery in the anal area is poor healing of the perineal wound. Between 1985 and 2000, 129 patients treated for anal cancer were retrospectively reviewed. Of the 24 patients with local failure, 18 patients were treated with an APR. The aim of this study was to review the results and long-term outcome after salvage APR, with special emphasis on perineal wound healing. Mean age at diagnosis was 59 (range: 41-83) years. After a median of 16 months, only 2 patients developed a local recurrence. The 5-year overall survival was 30%. In 11 patients the perineal wound was closed primarily, in 3 patients the perineal wound was left open, and in 4 patients a vertical rectus abdominus musculocutaneous (VRAM) flap was used. Perineal wound breakdown occurred in 5 of the 14 patients (36%) not treated with primary muscle reconstruction. In all patients treated with a VRAM flap the perineal wound healed primarily. In the present study salvage APR in recurrent or persistent anal cancer results in good local control and 5-year overall survival of 30%. When performing an APR a VRAM flap reconstruction should be considered to prevent disabling perineal wound complications.

  10. Identification of a Novel Human Papillomavirus, Type HPV199, Isolated from a Nasopharynx and Anal Canal, and Complete Genomic Characterization of Papillomavirus Species Gamma-12

    PubMed Central

    Oštrbenk, Anja; Kocjan, Boštjan J.; Hošnjak, Lea; Li, Jingjing; Deng, Qiuju; Šterbenc, Anja; Poljak, Mario

    2015-01-01

    The novel human papillomavirus type 199 (HPV199) was initially identified in a nasopharyngeal swab sample obtained from a 25 year-old immunocompetent male. The complete genome of HPV199 is 7,184 bp in length with a GC content of 36.5%. Comparative genomic characterization of HPV199 and its closest relatives showed the classical genomic organization of Gammapapillomaviruses (Gamma-PVs). HPV199 has seven major open reading frames (ORFs), encoding five early (E1, E2, E4, E6, and E7) and two late (L1 and L2) proteins, while lacking the E5 ORF. The long control region (LCR) of 513 bp is located between the L1 and E6 ORFs. Phylogenetic analysis additionally confirmed that HPV-199 clusters into the Gamma-PV genus, species Gamma-12, additionally containing HPV127, HV132, HPV148, HPV165, and three putative HPV types: KC5, CG2 and CG3. HPV199 is most closely related to HPV127 (nucleotide identity 77%). The complete viral genome sequence of additional HPV199 isolate was determined from anal canal swab sample. Two HPV199 complete viral sequences exhibit 99.4% nucleotide identity. To the best of our knowledge, this is the first member of Gamma-PV with complete nucleotide sequences determined from two independent clinical samples. To evaluate the tissue tropism of the novel HPV type, 916 clinical samples were tested using HPV199 type-specific real-time PCR: HPV199 was detected in 2/76 tissue samples of histologically confirmed common warts, 2/108 samples of eyebrow hair follicles, 2/137 anal canal swabs obtained from individuals with clinically evident anal pathology, 4/184 nasopharyngeal swabs and 3/411 cervical swabs obtained from women with normal cervical cytology. Although HPV199 was found in 1.4% of cutaneous and mucosal samples only, it exhibits dual tissue tropism. According to the results of our study and literature data, dual tropism of all Gamma-12 members is highly possible. PMID:26375679

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

    SciTech Connect

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

    2007-10-01

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

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

    SciTech Connect

    Mistrangelo, Massimiliano; Pelosi, Ettore; Bello, Marilena; Ricardi, Umberto; Milanesi, Enrica; Cassoni, Paola; Baccega, Massimo; Filippini, Claudia; Racca, Patrizia; Lesca, Adriana; Munoz, Fernando H.; Fora, Gianluca; Skanjeti, Andrea; Cravero, Francesca; Morino, Mario

    2012-09-01

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

  13. Human Papillomavirus Prevalence in Invasive Anal Cancers in the United States prior to Vaccine Introduction

    PubMed Central

    Steinau, M; Unger, ER; Hernandez, BY; Goodman, MT; Copeland, G; Hopenhayn, C; Cozen, W; Saber, MS; Huang, Y; Peters, ES; Lynch, CF; Wilkinson, EJ; Rajeevan, MS; Lyu, C; Saraiya, M

    2014-01-01

    Objective Conduct a representative survey of Human papillomavirus (HPV) prevalence and its genotype distribution in invasive anal cancer specimens in the U.S. Methods Population-based archival anal cancer specimens were identified from Florida, Kentucky, Louisiana and Michigan cancer registries and SEER tissue repositories in Hawaii, Iowa and Los Angeles. Sections from one representative block per case were used for DNA extraction. All extracts were assayed first by Linear Array and re-tested with INNO-LiPA if inadequate or HPV negative. Results Among 146 unique invasive anal cancer cases, 93 (63.7%) were from women and 53 (36.3%) from men. HPV (any type) was detected in 133 (91.1%) cases and 129 (88.4%) contained at least one high risk type, most (80.1%) as a single genotype. HPV16 had the highest prevalence (113 cases, 77.4%); HPV6, 11, 18 and 33 were also found multiple times. Among HPV16 positive cases, 37% were identified as prototype variant Ep and 63% were non-prototypes: 33% Em, 12% E-G131G, 5% Af1, 4% AA/NA-1, 3% E-C109G, 3% E-G131T, 2% As and 1% Af2. No significant differences in the distributions of HPV (any), high-risk types, or HPV16/18 were seen between gender, race or age group. Conclusions The establishment of pre-vaccine HPV prevalence in the U.S. is critical to the surveillance of vaccine efficacy. Almost 80% of anal cancers were positive for the vaccine types HPV16 or HPV18 and in 70% these were the only types detected suggesting that a high proportion might be preventable by current vaccines. PMID:23609590

  14. Risk of Anal Cancer in HIV-Infected and HIV-Uninfected Individuals in North America

    PubMed Central

    Lau, Bryan; Justice, Amy C.; Engels, Eric; Gill, M. John; Goedert, James J.; Kirk, Gregory D.; D’Souza, Gypsyamber; Bosch, Ronald J.; Brooks, John T.; Napravnik, Sonia; Hessol, Nancy A.; Jacobson, Lisa P.; Kitahata, Mari M.; Klein, Marina B.; Moore, Richard D.; Rodriguez, Benigno; Rourke, Sean B.; Saag, Michael S.; Sterling, Timothy R.; Gebo, Kelly A.; Press, Natasha; Martin, Jeffrey N.; Dubrow, Robert

    2012-01-01

    Background. Anal cancer is one of the most common cancers affecting individuals infected with human immunodeficiency virus (HIV), although few have evaluated rates separately for men who have sex with men (MSM), other men, and women. There are also conflicting data regarding calendar trends. Methods. In a study involving 13 cohorts from North America with follow-up between 1996 and 2007, we compared anal cancer incidence rates among 34 189 HIV-infected (55% MSM, 19% other men, 26% women) and 114 260 HIV-uninfected individuals (90% men). Results. Among men, the unadjusted anal cancer incidence rates per 100 000 person-years were 131 for HIV-infected MSM, 46 for other HIV-infected men, and 2 for HIV-uninfected men, corresponding to demographically adjusted rate ratios (RRs) of 80.3 (95% confidence interval [CI], 42.7–151.1) for HIV-infected MSM and 26.7 (95% CI, 11.5–61.7) for other HIV-infected men compared with HIV-uninfected men. HIV-infected women had an anal cancer rate of 30/100 000 person-years, and no cases were observed for HIV-uninfected women. In a multivariable Poisson regression model, among HIV-infected individuals, the risk was higher for MSM compared with other men (RR, 3.3; 95% CI, 1.8–6.0), but no difference was observed comparing women with other men (RR, 1.0; 95% CI, 0.5–2.2). In comparison with the period 2000–2003, HIV-infected individuals had an adjusted RR of 0.5 (95% CI, .3–.9) in 1996–1999 and 0.9 (95% CI, .6–1.2) in 2004–2007. Conclusions. Anal cancer rates were substantially higher for HIV-infected MSM, other men, and women compared with HIV-uninfected individuals, suggesting a need for universal prevention efforts. Rates increased after the early antiretroviral therapy era and then plateaued. PMID:22291097

  15. 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

  16. Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV

    PubMed Central

    Ong, Jason J; Fairley, Christopher K; Carroll, Susan; Walker, Sandra; Chen, Marcus; Read, Tim; Grulich, Andrew; Bradshaw, Catriona; Kaldor, John; Clarke, Philip

    2016-01-01

    Introduction Anal cancer in men who have sex with men (MSM) living with HIV is an important issue but there are no consistent guidelines for how to screen for this cancer. In settings where screening with anal cytology is unavailable, regular anal examinations have been proposed in some guidelines but their cost-effectiveness is unknown. Methods Our objective was to estimate the cost-effectiveness of regular anal examinations to screen for anal cancer in HIV-positive MSM living in Australia using a probabilistic Markov model. Data sources were based on the medical literature and a clinical trial of HIV-positive MSM receiving an annual anal examination in Australia. The main outcome measures for calculating effectiveness were undiscounted and discounted (at 3%) lifetime costs, life years gained, quality-adjusted life years (QALY) gained and incremental cost-effectiveness ratio (ICER). Results Base-case analysis estimated the average cost of screening for and management of anal cancer ranged from $195 for no screening to $1,915 for lifetime annual screening of men aged ≥ 50. Screening of men aged ≥ 50 generated ICERs of $29,760 per QALY gained (for screening every four years), $32,222 (every three years) and $45,484 (every two years). Uncertainty for ICERs was mostly influenced by the cost (financially and decrease in quality of life) from a false-positive result, progression rate of anal cancer, specificity of the anal examination, the probability of detection outside a screening program and the discount rate. Conclusions Screening for anal cancer by incorporating regular anal examinations into routine HIV care for MSM aged ≥ 50 is most likely to be cost-effective by conventional standards. Given that anal pap smears are not widely available yet in many clinical settings, regular anal exams for MSM living with HIV to detect anal cancer earlier should be implemented. PMID:26942721

  17. The Study of the Prevention of Anal Cancer (SPANC): design and methods of a three-year prospective cohort study

    PubMed Central

    2013-01-01

    Background The incidence of human papillomavirus (HPV)-associated anal cancer is increasing in men who have sex with men (MSM). Screening for the presumed cancer precursor, high-grade anal squamous intraepithelial lesions (HSIL) in a manner analogous to cervical cancer screening has been proposed. Uncertainty remains regarding anal HPV natural history and the role of anal cytology and high-resolution anoscopy (HRA) as screening tests. Well-designed cohort studies are required to address these issues. Methods/design The SPANC study is a prospective study of the epidemiology of low-risk and high-risk anal HPV infection and related cytological and histological abnormalities in HIV-negative and HIV-positive homosexual men aged 35 years and over. The study aims to recruit 600 men from community-based settings in Sydney, Australia. There are six study visits over three years. At the first five visits men undergo a digital ano-rectal examination (DARE), an anal “Papanicolaou” (Pap) test for HPV detection, genotyping and anal cytology, followed by HRA and directed biopsy of any visible abnormalities. The men also complete a behavioural questionnaire before each visit. Questions include a detailed history of sexual behaviour, of anal symptoms, possible anal cancer risk factors and validated quality of life and psychosocial questions. Questionnaires are also completed 2 weeks and 3 months following the provision of test results and include questions on participant experience during the procedure and post-procedure symptoms, including pain and bleeding in addition to quality of life/ psychosocial outcomes. Discussion Recruitment for the study began in September 2010 and will conclude in mid-2015, with follow up continuing to 2018. Thus far, over 350 men have been recruited from a variety of community-based settings and are broadly representative of the target screening population. The SPANC study is one of only a small number of cohort studies globally to perform HPV

  18. Squamous Cell Carcinoma of the Anal Canal: Patterns and Predictors of Failure and Implications for Intensity-Modulated Radiation Treatment Planning

    SciTech Connect

    Wright, Jean L.; Patil, Sujata M.; Temple, Larissa K.F.; Minsky, Bruce D.; Saltz, Leonard B.; Goodman, Karyn A.

    2010-11-15

    Purpose: Intensity-modulated radiation treatment (IMRT) is increasingly used in the treatment of squamous cell carcinoma of the anal canal (SCCAC). Prevention of locoregional failure (LRF) using IMRT requires appropriate clinical target volume (CTV) definition. To better define the CTV for IMRT, we evaluated patterns and predictors of LRF in SCCAC patients given conventional radiation treatment. Methods and Materials: We reviewed records of 180 SCCAC patients treated with conventional radiation with or without chemotherapy at our institution between January 1990 and March 2007. All patients received radiation; the median primary tumor dose was 45 Gy. A total of 173 patients also received mitomycin-based chemotherapy. Results: Median follow-up was 40 months. Actuarial 3-year colostomy-free survival was 89% and overall survival (OS) 88%. Actuarial 3-year LRF was 23%. A total of 45 patients had LRF, with 35 (78%) occurring locally in the primary site (25 local only, 10 local and regional); however, 20 (44%) had regional components of failure within the pelvis or inguinal nodes (10 regional only, 10 local and regional). Cumulative sites of LRF (patients may have one or more site of failure) were as follows: primary, 35; inguinal, 8; external perianal, 5; common iliac, 4; presacral, 3; distal rectum, 2; external iliac, 2; and internal iliac, 2. All patients with common iliac failure had cT3 or N+ disease. Conclusions: The observed patterns of failure support inclusion of the inguinal and all pelvic nodal groups in the CTV for IMRT. In patients with advanced tumor or nodal stage, common iliac nodes should also be included in the CTV.

  19. One compared with two cycles of mitomycin C in chemoradiotherapy for anal cancer: analysis of outcomes and toxicity

    PubMed Central

    Yeung, R.; McConnell, Y.; Roxin, G.; Banerjee, R.; Urgoiti, G.B. Roldán; MacLean, A.R.; Buie, W.D.; Mulder, K.E.; Vickers, M.M.; Joseph, K.J.; Doll, C.M.

    2014-01-01

    Background Concurrent chemoradiation with fluorouracil (5fu) and mitomycin C (mmc) is standard treatment for anal canal carcinoma (acc). The current protocol in Alberta is administration of 5fu and mmc during weeks 1 and 5 of radiation. However, administration of the second bolus of mmc has been based largely on centre preference. Given limited published data on outcomes with different mmc regimens, our objective was to compare the efficacy and toxicity of 1 compared with 2 cycles of mmc in acc treatment. Methods Our retrospective study evaluated 169 acc patients treated with radical chemoradiotherapy between 2000 and 2010 at two tertiary cancer centres. All patients were treated with 2 cycles of 5fu and with 1 cycle (mmc1) or 2 cycles (mmc2) of mmc. Acute toxicities, disease-free (dfs) and overall survival (os) were analyzed. Results Baseline demographics, performance status, and stage were similar in the groups of patients who received mmc1 (52%) and mmc2 (48%). Before treatment, median hematologic parameters were comparable, except for white blood cell count, which was higher in the mmc2 group, but within normal range. The 5-year os and dfs were similar (75.1% and 54.2% for mmc1 vs. 70.7% and 44.2% for mmc2, p = 0.98 and p = 0.63 respectively). On multivariate analysis, mmc2 was the factor most strongly associated with specific acute toxicities: grade 3+ leukopenia (hazard ratio: 4.82; p < 0.01), grade 3+ skin toxicity (hazard ratio: 4.76; p < 0.001), and hospitalizations secondary to febrile neutropenia (hazard ratio: 9.91; p = 0.001). Conclusions In definitive chemoradiotherapy for acc, 1 cycle of mmc appears to offer outcomes similar to those achieved with 2 cycles, with significantly less acute toxicity. PMID:24940105

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

    PubMed

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

    2016-12-01

    Antibodies against the Human papillomavirus 16 (HPV16) E6 oncoprotein appear years prior to clinical diagnosis of anal and oropharyngeal cancer, but whether they develop around the time of HPV infection is unclear. Serum samples from 173 cancer-free men from the Human Papillomavirus Infection in Men (HIM) Study were tested for HPV antibodies and DNA. HPV16 E6 seropositivity was low among men with oral HPV16-infection (1/28; 3.6%, 95%CI=0.0%-18.4%), anal HPV16-infection (1/61; 1.6%, 95%CI=0.0%-8.8%), and 24-month persistent genital HPV16-infection (1/84; 1.2%, 0.0-6.5%). This suggests E6 seroconversion may not occur around the time of oral, anal, or genital HPV16 acquisition.

  1. [Guidelines for delineation of pelvic lymph nodes in anal cancer treatment].

    PubMed

    Vendrely, V; Galland-Girodet, S; Orré, M; Maire, J-P

    2013-10-01

    Squamous cell anal cancer is a rare malignancy, its incidence increases due to higher exposure of the young adults to risk factors. The current management is based on chemoradiotherapy, which is highly effective and achieves locoregional control but causes important morbidity. Improvement of radiation technique such as intensity modulated radiation therapy has led to reduce acute toxicities, but also requires an accurate delineation of the target volumes in order not to underestimate potential and pathological sites resulting in an increase of the locoregional failures. PET scanner has an important place in the pretreatment work-up for staging and targeting the delineation of the volumes, allowing to select patients with localized disease, avoid geographic miss and appropriately boost nodal disease. The study of recurrences sites has not yet provided a real mapping of the recurrences depending on the treatment volumes. Different radiation oncologist cooperative groups have published guidelines and tools for delineation, in order to provide homogeneity but also customize the management of anal carcinoma.

  2. Cancer of the external auditory canal and temporal bone.

    PubMed

    Kuhel, W I; Hume, C R; Selesnick, S H

    1996-10-01

    Malignant tumors involving the structures of the temporal bone represent formidable diagnostic and therapeutic challenges for clinicians involved in the treatment of otologic disease. This article offers a perspective on the current understanding of the biology of malignancies involving the external auditory canal, middle ear space, and temporal bone, and reviews the often confusing and contradictory literature on this topic.

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

    SciTech Connect

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

    2012-06-01

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

  4. Mean Absorbed Dose to the Anal-Sphincter Region and Fecal Leakage among Irradiated Prostate Cancer Survivors

    SciTech Connect

    Alsadius, David; Hedelin, Maria; Lundstedt, Dan; Pettersson, Niclas; Wilderaeng, Ulrica; Steineck, Gunnar

    2012-10-01

    Purpose: To supplement previous findings that the absorbed dose of ionizing radiation to the anal sphincter or lower rectum affects the occurrence of fecal leakage among irradiated prostate-cancer survivors. We also wanted to determine whether anatomically defining the anal-sphincter region as the organ at risk could increase the degree of evidence underlying clinical guidelines for restriction doses to eliminate this excess risk. Methods and Materials: We identified 985 men irradiated for prostate cancer between 1993 and 2006. In 2008, we assessed long-term gastrointestinal symptoms among these men using a study-specific questionnaire. We restrict the analysis to the 414 men who had been treated with external beam radiation therapy only (no brachytherapy) to a total dose of 70 Gy in 2-Gy daily fractions to the prostate or postoperative prostatic region. On reconstructed original radiation therapy dose plans, we delineated the anal-sphincter region as an organ at risk. Results: We found that the prevalence of long-term fecal leakage at least once per month was strongly correlated with the mean dose to the anal-sphincter region. Examining different dose intervals, we found a large increase at 40 Gy; {>=}40 Gy compared with <40 Gy gave a prevalence ratio of 3.8 (95% confidence interval 1.6-8.6). Conclusions: This long-term study shows that mean absorbed dose to the anal-sphincter region is associated with the occurrence of long-term fecal leakage among irradiated prostate-cancer survivors; delineating the anal-sphincter region separately from the rectum and applying a restriction of a mean dose <40 Gy will, according to our data, reduce the risk considerably.

  5. Predictors and Patterns of Recurrence After Definitive Chemoradiation for Anal Cancer

    SciTech Connect

    Das, Prajnan . E-mail: PrajDas@mdanderson.org; Bhatia, Sumita; Eng, Cathy; Ajani, Jaffer A.; Skibber, John M.; Rodriguez-Bigas, Miguel A.; Chang, George J.; Bhosale, Priya; Delclos, Marc E.; Krishnan, Sunil; Janjan, Nora A.; Crane, Christopher H.

    2007-07-01

    Purpose: To evaluate patterns of locoregional failure, and predictors of recurrence and survival in patients treated with chemoradiation for anal cancer. Methods and Materials: Between September 1992 and August 2004, 167 patients with nonmetastatic squamous cell anal carcinoma were treated with definitive chemoradiation. The median dose of radiotherapy was 5500 cGy. Concurrent chemotherapy was given with 5-fluorouracil and cisplatin in 117 patients, 5-fluorouracil and mitomycin C in 24 patients, and other regimens in 26 patients. Results: The estimated 3-year rates of locoregional control, distant control, disease-free survival, and overall survival were 81%, 88%, 67%, and 84%, respectively. Multivariate analysis showed that higher T stage and N stage independently predicted for a higher rate of locoregional failure; higher N stage and basaloid subtype independently predicted for a higher rate of distant metastasis; and higher N stage and positive human immunodeficiency virus status independently predicted for a lower rate of overall survival. Among the patients who had locoregional failure, 18 (75%) had failure involving the anus or rectum, 5 (21%) had other pelvic recurrences, and 1 (4%) had inguinal recurrence. The 5 pelvic recurrences all occurred in patients with the superior border of the radiotherapy field at the bottom of the sacroiliac joint. Conclusions: Trials of more aggressive and innovative locoregional and systemic therapies are warranted in high-risk patients, based on their T and N stages. The majority of locoregional failures involve the anus and rectum, whereas inguinal recurrences occur rarely. Placing the superior border of the radiotherapy field at L5/S1 could potentially reduce pelvic recurrences.

  6. Australasian Gastrointestinal Trials Group (AGITG) Contouring Atlas and Planning Guidelines for Intensity-Modulated Radiotherapy in Anal Cancer

    SciTech Connect

    Ng, Michael; Leong, Trevor; Chander, Sarat; Chu, Julie; Kneebone, Andrew; Carroll, Susan; Wiltshire, Kirsty; Ngan, Samuel; Kachnic, Lisa

    2012-08-01

    Purpose: To develop a high-resolution target volume atlas with intensity-modulated radiotherapy (IMRT) planning guidelines for the conformal treatment of anal cancer. Methods and Materials: A draft contouring atlas and planning guidelines for anal cancer IMRT were prepared at the Australasian Gastrointestinal Trials Group (AGITG) annual meeting in September 2010. An expert panel of radiation oncologists contoured an anal cancer case to generate discussion on recommendations regarding target definition for gross disease, elective nodal volumes, and organs at risk (OARs). Clinical target volume (CTV) and planning target volume (PTV) margins, dose fractionation, and other IMRT-specific issues were also addressed. A steering committee produced the final consensus guidelines. Results: Detailed contouring and planning guidelines and a high-resolution atlas are provided. Gross tumor and elective target volumes are described and pictorially depicted. All elective regions should be routinely contoured for all disease stages, with the possible exception of the inguinal and high pelvic nodes for select, early-stage T1N0. A 20-mm CTV margin for the primary, 10- to 20-mm CTV margin for involved nodes and a 7-mm CTV margin for the elective pelvic nodal groups are recommended, while respecting anatomical boundaries. A 5- to 10-mm PTV margin is suggested. When using a simultaneous integrated boost technique, a dose of 54 Gy in 30 fractions to gross disease and 45 Gy to elective nodes with chemotherapy is appropriate. Guidelines are provided for OAR delineation. Conclusion: These consensus planning guidelines and high-resolution atlas complement the existing Radiation Therapy Oncology Group (RTOG) elective nodal ano-rectal atlas and provide additional anatomic, clinical, and technical instructions to guide radiation oncologists in the planning and delivery of IMRT for anal cancer.

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

    SciTech Connect

    Zilli, Thomas; Betz, Michael; Bieri, Sabine; Ris, Frederic; Roche, Bruno; Roth, Arnaud D.; Allal, Abdelkarim S.

    2013-09-01

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

  8. Isolation and antimicrobial susceptibility of bacteria from external ear canal of cancer patients at Shafa Cancer Hospital-Ahwaz.

    PubMed

    Kalantar, E; Mosaei, M; Ekrami, A; Pedram, M

    2006-01-01

    A bacteriological study of external ear canal was performed in 52 hospitalized cancer patients and 42 non hospitalized cancer patients at Shafa hospital, Ahwaz. Study was under taken to find out the normal flora changes in the external ear canals and to observe the prevalence of external otitis among these cancer patients. The control group consisted of 40 non-cancer patients. We observed the following bacteria among hospitalized cancer patients. Staphylococcus Coagulase negative (51.9%), Staphylococcus aureus (15.7%) and Streptococcus pneumoniae (11.9%). Similarly, among non hospitalized cancer patients, Staphylococcus Coagulase negative (45.2%), S. aureus (9.5%) and Streptococcus pneumoniae (4.7%). Incidence of Staphylococcus Coagulase negative and Streptococci pneumoniae is higher in control group than that in cancer patients. We have concluded that cancer patients probably suffer from external otitis more frequently because of enhanced colonization by S. aureus (P < 0.05). The antimicrobial susceptibility of these organisms to various antibiotics was determined by disk diffusion method using Muller Hinton agar. In hospitalized cancer patients Staphylococcus Coagulase negative was 25% and 85% resistant to Vancomycin and Penicillin G and in non hospitalized cancer patients, Staphylococcus Coagulase negative were 45% and 80% resistant to Vancomycin and Penicillin G. S. aureus of both the groups (hospitalized & non hospitalized) were resistant to Penicillin G. Similarly, both the groups were 55% and 50% resistance to Vancomycin.

  9. Laparoscopic total mesorectal excision of low rectal cancer with preservation of anal sphincter: A report of 82 cases

    PubMed Central

    Zhou, Zong-Guang; Wang, Zhao; Yu, Yong-Yang; Shu, Ye; Cheng, Zhong; Li, Li; Lei, Wen-Zhang; Wang, Tian-Cai

    2003-01-01

    AIM: To assess the feasibility and efficacy of laparoscopic total mesorectal excision (LTME) of low rectal cancer with preservation of anal sphincter. METHODS: From June 2001 to June 2003, 82 patients with low rectal cancer underwent laparoscopic total mesorectal excision with preservation of anal sphincter. The lowest edge of tumors was below peritoneal reflection and 1.5-7 cm from the dentate line (1.5-5 cm in 48 cases, 5-7 cm in 34 cases). RESULTS: LTME with anal sphincter preservation was performed on 82 randomized patients with low rectal cancer, and 100% sphincter preservation rate was achieved. There were 30 patients with laparoscopic low anterior resection (LLAR) at the level of the anastomosis below peritoneal reflection and 2 cm above from the dentate line; 27 patients with laparoscopic ultralow anterior resection (LULAR) at the level of anastomoses 2 cm below from the dentate line; and 25 patients with laparoscopic coloanal anastomoses (LCAA) at the level of the anastomoses at or below the dentate line. No defunctioning ileostomy was created in any case. The mean operating time was 120 min (ranged from 110-220 min), and the mean operative blood loss was 20 mL (ranged from 5-120 mL). Bowel function was restored and diet was resumed on day 1 or 2 after operation. The mean hospital stay was 8 d (ranged from 5-14). Postoperative analgesics were used in 45 patients. After surgery, 2 patients had urinary retention, one had anastomotic leakage, and another 2 patients had local recurrence one year later. No interoperative complication was observed. CONCLUSION: LTME with preservation of anal sphincter is a feasible, safe and minimally invasive technique with less postoperative pain and rapid recovery, and importantly, it has preserved the function of the sphincter. PMID:12854145

  10. RTOG 0529: A Phase 2 Evaluation of Dose-Painted Intensity Modulated Radiation Therapy in Combination With 5-Fluorouracil and Mitomycin-C for the Reduction of Acute Morbidity in Carcinoma of the Anal Canal

    SciTech Connect

    Kachnic, Lisa A.; Winter, Kathryn; Myerson, Robert J.; Goodyear, Michael D.; Willins, John; Esthappan, Jacqueline; Haddock, Michael G.; Rotman, Marvin; Parikh, Parag J.; Safran, Howard; Willett, Christopher G.

    2013-05-01

    Purpose: A multi-institutional phase 2 trial assessed the utility of dose-painted intensity modulated radiation therapy (DP-IMRT) in reducing grade 2+ combined acute gastrointestinal and genitourinary adverse events (AEs) of 5-fluorouracil (5FU) and mitomycin-C (MMC) chemoradiation for anal cancer by at least 15% compared with the conventional radiation/5FU/MMC arm from RTOG 9811. Methods and Materials: T2-4N0-3M0 anal cancer patients received 5FU and MMC on days 1 and 29 of DP-IMRT, prescribed per stage: T2N0, 42 Gy elective nodal and 50.4 Gy anal tumor planning target volumes (PTVs) in 28 fractions; T3-4N0-3, 45 Gy elective nodal, 50.4 Gy ≤3 cm or 54 Gy >3 cm metastatic nodal and 54 Gy anal tumor PTVs in 30 fractions. The primary endpoint is described above. Planned secondary endpoints assessed all AEs and the investigator’s ability to perform DP-IMRT. Results: Of 63 accrued patients, 52 were evaluable. Tumor stage included 54% II, 25% IIIA, and 21% IIIB. In primary endpoint analysis, 77% experienced grade 2+ gastrointestinal/genitourinary acute AEs (9811 77%). There was, however, a significant reduction in acute grade 2+ hematologic, 73% (9811 85%, P=.032), grade 3+ gastrointestinal, 21% (9811 36%, P=.0082), and grade 3+ dermatologic AEs 23% (9811 49%, P<.0001) with DP-IMRT. On initial pretreatment review, 81% required DP-IMRT replanning, and final review revealed only 3 cases with normal tissue major deviations. Conclusions: Although the primary endpoint was not met, DP-IMRT was associated with significant sparing of acute grade 2+ hematologic and grade 3+ dermatologic and gastrointestinal toxicity. Although DP-IMRT proved feasible, the high pretreatment planning revision rate emphasizes the importance of real-time radiation quality assurance for IMRT trials.

  11. Intensity-Modulated Radiation Therapy for the Treatment of Squamous Cell Anal Cancer With Para-aortic Nodal Involvement

    SciTech Connect

    Hodges, Joseph C.; Das, Prajnan; Eng, Cathy; Reish, Andrew G.; Beddar, A. Sam; Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H.

    2009-11-01

    Purpose: To determine the rates of toxicity, locoregional control, distant control, and survival in anal cancer patients with para-aortic nodal involvement, treated with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy at a single institution. Methods and Materials: Between 2001 and 2007, 6 patients with squamous cell anal cancer and para-aortic nodal involvement were treated with IMRT and concurrent infusional 5-fluorouracil and cisplatin. The primary tumor was treated with a median dose of 57.5 Gy (range, 54-60 Gy), involved para-aortic, pelvic, and inguinal lymph nodes were treated with a median dose of 55 Gy (range, 50.5-55 Gy), and noninvolved nodal regions were treated with a median dose of 45 Gy (range, 43.5-45 Gy). Results: After a median follow-up of 25 months, none of the patients had a recurrence at the primary tumor, pelvic/inguinal nodes, or para-aortic nodes, whereas 2 patients developed distant metastases to the liver. Four of the 6 patients are alive. The 3-year actuarial locoregional control, distant control, and overall survival rates were 100%, 56%, and 63%, respectively. Four of the 6 patients developed Grade 3 acute gastrointestinal toxicity during chemoradiation. Conclusions: Intensity-modulated radiotherapy and concurrent chemotherapy could potentially serve as definitive therapy in anal cancer patients with para-aortic nodal involvement. Adjuvant chemotherapy may be indicated in these patients, as demonstrated by the distant failure rates. These patients need to be followed carefully because of the potential for treatment-related toxicities.

  12. Rectal bleeding and prolapse… not always benign diseases rather anal cancer. The importance of a correct decision making since primary care

    PubMed Central

    COCORULLO, G.; TUTINO, R.; FALCO, N.; FONTANA, T.; SALAMONE, G.; LICARI, L.; GULOTTA, G.

    2016-01-01

    Rectal bleeding is very common in general population with a prevalence of 10–20 %. Primary care physicians have to stratify patients basing on urgency and on the colo-rectal cancer risk and to conduct a decision making for the correct management. We report a case of a 61-years-old woman, complaining rectal bleeding and an anal mass attended to their family doctor who does a visit but without a digital rectal examination and diagnosed a hemorrhoidal prolapse suggesting medical therapy. For the persistence of symptoms she comes to our service from emergency attention. Inspection and digital rectal examination revealed an anal mass. CT scan was performed showing a large anal mass involving half anal circumference. Histologic samples showed an epithelial proliferation compatible with a squamous carcinoma. Oncological consult was requested and a chemo-radiotherapy treatment was proposed. This case report highlights the difficulty when physicians assess patients with anorectal complaints in differentiating anal cancer from benign disease, presumably because symptoms are similar. Primary care physicians must maintain a high index of suspicion of cancer in high-risk population. Sensitization of these colleagues is required since digital rectal examination is of inestimable value to verify the presence of a rectal or an anal mass. PMID:27734798

  13. Anal Fissure

    PubMed Central

    Beaty, Jennifer Sam; Shashidharan, M.

    2016-01-01

    Anal fissure (fissure-in-ano) is a very common anorectal condition. The exact etiology of this condition is debated; however, there is a clear association with elevated internal anal sphincter pressures. Though hard bowel movements are implicated in fissure etiology, they are not universally present in patients with anal fissures. Half of all patients with fissures heal with nonoperative management such as high fiber diet, sitz baths, and pharmacological agents. When nonoperative management fails, surgical treatment with lateral internal sphincterotomy has a high success rate. In this chapter, we will review the symptoms, pathophysiology, and management of anal fissures. PMID:26929749

  14. Anal fissure

    MedlinePlus

    ... bath 2 to 3 times a day. The water should cover only the hips and buttocks. If the anal fissures do not go away with home care methods, treatment may involve: Botox injections into the muscle in the anus (anal sphincter) ...

  15. Cryptoglandular anal fistula.

    PubMed

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

    2010-08-01

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

  16. A comparison between 5-fluorouracil/mitomycin and capecitabine/mitomycin in combination with radiation for anal cancer

    PubMed Central

    Wan, Dante D.; Schellenberg, Devin; Lim, Howard J.

    2016-01-01

    Background There are no randomized phase III trials comparing 5-fluorouracil/mitomycin (FM) versus capecitabine/mitomycin (CM) in combination with radiotherapy (RT) for locally advanced anal cancer. We aim to evaluate the outcomes of patients treated with FM and CM at our institution. Methods Patients with stage I–III anal cancer who initiated curative-intent RT (50–54 Gy) with either CM or FM between 1998 and 2013 at the BC Cancer Agency were reviewed. Cox proportional models were used to analyze the impact of regimen on disease-free survival (DFS) and anal cancer-specific survival (ACSS). Results A total of 300 patients were included. Baseline characteristics were well-distributed between the groups. A total of 194 patients (64.6%) received FM and 106 (35.3%) CM. The 2-year DFS was 79.7% for CM [95% confidence intervals (95% CI), 71.1–88.3%] and 78.8% for FM (95% CI, 73–84.6%); 2-year ACSS was 88.7% for CM (95% CI, 81.8–95.5%) and 87.5% for FM (95% CI, 82.8–92.2%). On multivariate analysis, only HIV status, clinical T size (≤5 vs. >5 cm), and N status (negative vs. positive) remained as significant prognostic factors for both DFS and ACSS. Chemotherapy regimen (CM vs. FM) had no impact on either DFS [P=0.995; hazard ratios (HR) =0.99; 95% CI, 0.57–1.74] or ACSS (P=0.847; HR =0.93; 95% CI, 0.46–1.86). Conclusions In our population-based study, CM and FM concomitant with RT achieved similar DFS and ACSS. Substitution of capecitabine for infusional 5-FU may therefore be a reasonable option for patients and physicians who prefer to avoid the inconvenience and potential complications of a central infusional device. PMID:27563458

  17. Mandibular Canal Widening and Bell's Palsy: Sequelae of Perineural Invasion in Oral Cancer

    PubMed Central

    Sundar, Gopinath Thilak Parepady; Sherigar, Vishwanath; Satya, Shree; Gohil, Sourabh M.

    2016-01-01

    Perineural invasion is an underrecognized route of metastatic spread along the nerve bundles within the nerve sheath into the surrounding tissues. It hinders the ability to establish local control as tumour cells can traverse along nerve tracts well beyond the extent of any local invasion rendering them inoperable and unresectable. Perineural invasion is a marker of poor prognosis. Oral submucous fibrosis with oral cancer constitutes a clinicopathologically distinct disease. Our case highlights an enigmatic presentation of oral submucous fibrosis and its coexistence with oral cancer presenting with unusual neurological disturbance of the inferior alveolar nerve and facial nerve and diffuse widening of the mandibular canal. The objective of this case report is to enumerate the significance of perineural invasion in determining the course of the disease and necessitate the need for future studies that can shed light on molecular mediators and pathogenesis of perineural spread. PMID:28025626

  18. Mandibular Canal Widening and Bell's Palsy: Sequelae of Perineural Invasion in Oral Cancer.

    PubMed

    Sundar, Gopinath Thilak Parepady; Sherigar, Vishwanath; Shetty, Sameep S; Satya, Shree; Gohil, Sourabh M

    2016-01-01

    Perineural invasion is an underrecognized route of metastatic spread along the nerve bundles within the nerve sheath into the surrounding tissues. It hinders the ability to establish local control as tumour cells can traverse along nerve tracts well beyond the extent of any local invasion rendering them inoperable and unresectable. Perineural invasion is a marker of poor prognosis. Oral submucous fibrosis with oral cancer constitutes a clinicopathologically distinct disease. Our case highlights an enigmatic presentation of oral submucous fibrosis and its coexistence with oral cancer presenting with unusual neurological disturbance of the inferior alveolar nerve and facial nerve and diffuse widening of the mandibular canal. The objective of this case report is to enumerate the significance of perineural invasion in determining the course of the disease and necessitate the need for future studies that can shed light on molecular mediators and pathogenesis of perineural spread.

  19. Comparison of anal cancer outcomes in public and private hospital patients treated at a single radiation oncology center

    PubMed Central

    Bitterman, Danielle S.; Grew, David; Gu, Ping; Cohen, Richard F.; Sanfilippo, Nicholas J.; Leichman, Cynthia G.; Leichman, Lawrence P.; Moore, Harvey G.; Gold, Heather T.

    2015-01-01

    Objective To compare clinical and treatment characteristics and outcomes in locally advanced anal cancer, a potentially curable disease, in patients referred from a public or private hospital. Methods We retrospectively reviewed 112 anal cancer patients from a public and a private hospital who received definitive chemoradiotherapy at the same cancer center between 2004 and 2013. Tumor stage, radiotherapy delay, radiotherapy duration, and unplanned treatment breaks ≥10 days were compared using t-test and χ2 test. Overall survival (OS), disease free survival (DFS), and colostomy free survival (CFS) were examined using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazard models for OS and DFS were developed. Results The follow-up was 14.9 months (range, 0.7-94.8 months). Public hospital patients presented with significantly higher clinical T stage (P<0.05) and clinical stage group (P<0.05), had significantly longer radiotherapy delays (P<0.05) and radiotherapy duration (P<0.05), and had more frequent radiation therapy (RT) breaks ≥10 days (P<0.05). Three-year OS showed a marked trend in favor of private hospital patients for 3-year OS (72.8% vs. 48.9%; P=0.171), 3-year DFS (66.3% vs. 42.7%, P=0.352), and 3-year CFS (86.4% vs. 68.9%, P=0.299). Referral hospital was not predictive of OS or DFS on multivariate analysis. Conclusions Public hospital patients presented at later stage and experienced more delays in initiating and completing radiotherapy, which may contribute to the trend in poorer DFS and OS. These findings emphasize the need for identifying clinical and treatment factors that contribute to decreased survival in low socioeconomic status (SES) populations. PMID:26487947

  20. Cost-Effectiveness Analysis of Intensity Modulated Radiation Therapy Versus 3-Dimensional Conformal Radiation Therapy for Anal Cancer

    SciTech Connect

    Hodges, Joseph C.; Beg, Muhammad S.; Das, Prajnan; Meyer, Jeffrey

    2014-07-15

    Purpose: To compare the cost-effectiveness of intensity modulated radiation therapy (IMRT) and 3-dimensional conformal radiation therapy (3D-CRT) for anal cancer and determine disease, patient, and treatment parameters that influence the result. Methods and Materials: A Markov decision model was designed with the various disease states for the base case of a 65-year-old patient with anal cancer treated with either IMRT or 3D-CRT and concurrent chemotherapy. Health states accounting for rates of local failure, colostomy failure, treatment breaks, patient prognosis, acute and late toxicities, and the utility of toxicities were informed by existing literature and analyzed with deterministic and probabilistic sensitivity analysis. Results: In the base case, mean costs and quality-adjusted life expectancy in years (QALY) for IMRT and 3D-CRT were $32,291 (4.81) and $28,444 (4.78), respectively, resulting in an incremental cost-effectiveness ratio of $128,233/QALY for IMRT compared with 3D-CRT. Probabilistic sensitivity analysis found that IMRT was cost-effective in 22%, 47%, and 65% of iterations at willingness-to-pay thresholds of $50,000, $100,000, and $150,000 per QALY, respectively. Conclusions: In our base model, IMRT was a cost-ineffective strategy despite the reduced acute treatment toxicities and their associated costs of management. The model outcome was sensitive to variations in local and colostomy failure rates, as well as patient-reported utilities relating to acute toxicities.

  1. High-Dose Split-Course Radiation Therapy for Anal Cancer: Outcome Analysis Regarding the Boost Strategy (CORS-03 Study)

    SciTech Connect

    Hannoun-Levi, Jean-Michel; Ortholan, Cecile; Resbeut, Michel; Teissier, Eric; Ronchin, Philippe; Cowen, Didier; Zaccariotto, Audrey; Benezery, Karen; Francois, Eric; Salem, Naji; Ellis, Steve; Azria, David; Gerard, Jean-Pierre

    2011-07-01

    Purpose: To retrospectively assess the clinical outcome in anal cancer patients treated with split-course radiation therapy and boosted through external-beam radiation therapy (EBRT) or brachytherapy (BCT). Methods and Materials: From January 2000 to December 2004, a selected group (162 patients) with invasive nonmetastatic anal squamous cell carcinoma was studied. Tumor staging reported was T1 = 31 patients (19%), T2 = 77 patients (48%), T3 = 42 patients (26%), and T4= 12 patients (7%). Lymph node status was N0-1 (86%) and N2-3 (14%). Patients underwent a first course of EBRT: mean dose 45.1 Gy (range, 39.5-50) followed by a boost: mean dose 17.9 Gy (range, 8-25) using EBRT (76 patients, 47%) or BCT (86 patients, 53%). All characteristics of patients and tumors were well balanced between the BCT and EBRT groups. Results: The mean overall treatment time (OTT) was 82 days (range, 45-143) and 67 days (range, 37-128) for the EBRT and BCT groups, respectively (p < 0.001). The median follow-up was 62 months (range, 2-108). The 5-year cumulative rate of local recurrence (CRLR) was 21%. In the univariate analysis, the prognostic factors for CRLR were as follows: T stage (T1-2 = 15% vs. T3-4 = 36%, p = 0.03), boost technique (BCT = 12% vs. EBRT = 33%, p = 0.002) and OTT (OTT <80 days = 14%, OTT {>=}80 days = 34%, p = 0.005). In the multivariate analysis, BCT boost was the unique prognostic factor (hazard ratio = 0.62 (0.41-0.92). In the subgroup of patients with OTT <80 days, the 5-year CRLR was significantly increased with the BCT boost (BC = 9% vs. EBRT = 28%, p = 0.03). In the case of OTT {>=}80 days, the 5-year CRLR was not affected by the boost technique (BCT = 29% vs. EBRT = 38%, p = 0.21). Conclusion: In anal cancer, when OTT is <80 days, BCT boost is superior to EBRT boost for CRLR. These results suggest investigating the benefit of BCT boost in prospective trials.

  2. Exposing the gaps in awareness, knowledge and estimation of risk for anal cancer in men who have sex with men living with HIV: a cross-sectional survey in Australia

    PubMed Central

    Ong, Jason J; Chen, Marcus; Grulich, Andrew; Walker, Sandra; Temple-Smith, Meredith; Bradshaw, Catriona; Garland, Suzanne M; Hillman, Richard; Templeton, David; Hocking, Jane; Eu, Beng; Tee, BK; Fairley, Christopher K

    2015-01-01

    Introduction The incidence of anal cancer is significantly higher in men who have sex with men (MSM) living with HIV when compared to the general population. We aimed to assess their awareness, knowledge and perceived level of personal risk for anal cancer to help inform educational strategies targeting this group. Methods A cross-sectional study of 327 HIV positive MSM in Melbourne, Australia, attending clinical settings (a sexual health centre, tertiary hospital HIV outpatients and high HIV caseload general practices) completed a written questionnaire in 2013/14. Poor knowledge was defined as those who had never heard of anal cancer, or scored 5 or less out of 10 in knowledge questions amongst those who reported ever hearing about anal cancer. Underestimation of risk was defined as considering themselves as having the same or lower risk for anal cancer compared to the general population. Results Of 72% (95% confidence interval (CI): 67–77) who had heard of anal cancer, 47% (95% CI: 41–53) could not identify any risk factors for anal cancer. Of total men surveyed, 51% (95% CI: 46–57) underestimated their risk for anal cancer. Multivariate analysis showed that men who underestimated their risk were older (OR 1.04 (per year increase in age), 95% CI: 1.01–1.07), had poor anal cancer knowledge (OR 2.06, 95% CI: 1.21–3.51), and more likely to have ever had an anal examination (OR 2.41, 95% CI: 1.18–4.93). They were less likely to consult a physician if they had an anal abnormality (OR 0.54, 95% CI: 0.31–0.96), to have had receptive anal sex (OR 0.12, 95% CI: 0.02–0.59) or speak English at home (OR 0.28, 95% CI: 0.09–0.90). Conclusions This survey of MSM living with HIV demonstrated limited awareness, knowledge level and estimation of risk for anal cancer. Further educational and public health initiatives are urgently needed to improve knowledge and understanding of anal cancer risk in MSM living with HIV. PMID:25828269

  3. EXTRA-A Multicenter Phase II Study of Chemoradiation Using a 5 Day per Week Oral Regimen of Capecitabine and Intravenous Mitomycin C in Anal Cancer

    SciTech Connect

    Glynne-Jones, Rob Meadows, Helen; Wan, Susan; Gollins, Simon; Leslie, Martin; Levine, Ed; McDonald, Alec C.; Myint, Sun; Samuel, Les; Sebag-Montefiore, David

    2008-09-01

    Purpose: 5-Fluorouracil (5-FU) + mitomycin C (MMC)-based chemoradiotherapy is standard treatment for patients with epidermoid anal carcinoma. Clinical trials in other cancers have confirmed 5-FU can successfully be replaced by the oral fluoropyrimidine capecitabine. This phase II trial aimed to determine the feasibility, toxicity, and efficacy of capecitabine, MMC and radiotherapy (RT) in anal cancer patients. Methods and Materials: Radiotherapy comprised the schedule of the UK Anal Cancer Trial (ACT) II trial (50.4 Gy in 28 fractions of 1.8 Gy). With MMC (12 mg/m{sup 2}) on Day 1 and capecitabine on each RT treatment day in two divided doses (825 mg/m{sup 2} b.i.d). The endpoints were complete response at 4 weeks, local control at 6 months and toxicity. Results: Thirty-one patients entered the trial. The median age was 61 years (range 45-86) with 14 males and 17 females. Compliance with chemotherapy with no dose interruptions or delays was 68%, and with RT was 81%. Eighteen (58%) patients completed both modalities of treatment as planned. Dose-limiting Grade 3 or 4 diarrhea was seen in 1 of 31 patients. Three patients experienced Grade 3 neutropenia. There were no treatment-related deaths. Four weeks following completion of chemoradiation, 24 patients (77%) had a complete clinical response, and 4 (16%) a partial response. With a median follow-up of 14 months, three locoregional relapses occurred. Conclusions: Capecitabine with MMC and RT in with patients anal carcinoma is well tolerated, with minimal toxicity and acceptable compliance. We recommend testing this schedule in future national Phase III studies in anal cancer.

  4. Diagnostic performance of magnetic resonance imaging and 3D endoanal ultrasound in detection, staging and assessment post treatment, in anal cancer.

    PubMed

    Reginelli, Alfonso; Granata, Vincenza; Fusco, Roberta; Granata, Francesco; Rega, Daniela; Roberto, Luca; Pellino, Gianluca; Rotondo, Antonio; Selvaggi, Francesco; Izzo, Francesco; Petrillo, Antonella; Grassi, Roberto

    2017-02-01

    We compared Magnetic Resonance Imaging (MRI) and 3D Endoanal Ultrasound (EAUS) imaging performance to confirm anal carcinoma and to monitor treatment response.58 patients with anal cancer were retrospectively enrolled. All patients underwent clinical examination, anoscopic examination; EAUS and contrast-enhanced MRI study before and after treatment. Four radiologists evaluated the presence of lesions, using a 4-point confidence scale, features of the lesion and nodes on EAUS images, T1-weighted (T1-W), T2-weighted (T2-W) and diffusion-weighted images (DWI) signal intensity (SI), the apparent diffusion coefficient (ADC) map for nodes and lesion, as well as enhancement pattern during dynamic MRI were assessed.All lesions were detected by EAUS while MRI detected 93.1% of anal cancer. MRI showed a good correlation with EAUS, anoscopy and clinical examination. The residual tissue not showed significant difference in EAUS assessment and T2-W SI in pre and post treatment. We found significant difference in dynamic study, in SI of DWI, in ADC map and values among responder's patients in pre and post treatment. The neoplastic nodes were hypoecoic on EAUS, with hyperintense signal on T2-W sequences and hypointense signal on T1-W. The neoplastic nodes showed SI on DWI sequences and ADC value similar to anal cancer. We found significant difference in nodes status in pre and post therapy on DWI data.3D EAUS and MRI are accurate techniques in anal cancer staging, although EAUS is more accurate than MRI for T1 stage. MRI allows correct detection of neoplastic nodes and can properly stratify patients into responders or non responders.

  5. Dosimetric Predictors of Radiation-Induced Vaginal Stenosis After Pelvic Radiation Therapy for Rectal and Anal Cancer

    SciTech Connect

    Son, Christina H.; Law, Ethel; Oh, Jung Hun; Apte, Aditya P.; Yang, T. Jonathan; Riedel, Elyn; Wu, Abraham J.; Deasy, Joseph O.; Goodman, Karyn A.

    2015-07-01

    Purpose: Although vaginal stenosis (VS) is a recognized toxicity in women who receive pelvic radiation therapy (RT), the relationship between RT dose and the volume and extent of toxicity has not been analyzed. We modeled this relationship to identify predictors of VS. Methods and Materials: We evaluated 54 women, aged 29 to 78 years, who underwent pelvic RT for rectal or anal cancer during 2008 to 2011 and were enrolled in a prospective study evaluating vaginal dilator use. Maximum dilator size was measured before RT (baseline) and 1 month and 12 months after RT. Dilator use was initiated at 1 month. The difference (D) in dilator size before and after RT was recorded. Those with D ≤−1 were classified as having VS (n=35); those with D ≥0 were classified as having no VS (n=19 at 1 month). Dose-volume parameters were extracted, and the generalized equivalent uniform dose (gEUD) was used to build a predictive model. Results: The mean vaginal doses were 50.0 Gy and 36.8 Gy for anal and rectal cancer patients, respectively. One month after RT, a gEUD model using a wide range of a values suggests that sparing of vaginal volume to a low dose may be important. When gEUD (a = −1) was <35 Gy and the mean vaginal dose was <43 Gy, severe VS was reduced (P=.02). A 1-year analysis suggests increasingly negative D values with increasing mean dose. However, patients with compliance <40% were more likely to have toxicity. Conclusions: Vaginal stenosis is influenced by multiple RT dose-volume characteristics. Mean dose and gEUD constraints together may reduce the risk of severe VS. Patients receiving higher mean vaginal doses should have greater compliance with dilator therapy to minimize risk of toxicity. Further validation with independent datasets is needed.

  6. Association Between Bone Marrow Dosimetric Parameters and Acute Hematologic Toxicity in Anal Cancer Patients Treated With Concurrent Chemotherapy and Intensity-Modulated Radiotherapy

    SciTech Connect

    Mell, Loren K. Schomas, David A.; Salama, Joseph K.; Devisetty, Kiran; Aydogan, Bulent; Miller, Robert C.; Jani, Ashesh B.; Kindler, Hedy L.; Roeske, John C.; Chmura, Steven J.

    2008-04-01

    Purpose: To test the hypothesis that the volume of pelvic bone marrow (PBM) receiving 10 and 20 Gy or more (PBM-V{sub 10} and PBM-V{sub 20}) is associated with acute hematologic toxicity (HT) in anal cancer patients treated with concurrent chemoradiotherapy. Methods and Materials: We analyzed 48 consecutive anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiation therapy. The median radiation dose to gross tumor and regional lymph nodes was 50.4 and 45 Gy, respectively. Pelvic bone marrow was defined as the region extending from the iliac crests to the ischial tuberosities, including the os coxae, lumbosacral spine, and proximal femora. Endpoints included the white blood cell count (WBC), absolute neutrophil count (ANC), hemoglobin, and platelet count nadirs. Regression models with multiple independent predictors were used to test associations between dosimetric parameters and HT. Results: Twenty patients (42%) had Stage T3-4 disease; 15 patients (31%) were node positive. Overall, 27 (56%), 24 (50%), 4 (8%), and 13 (27%) experienced acute Grade 3-4 leukopenia, neutropenia, anemia, and thrombocytopenia, respectively. On multiple regression analysis, increased PBM-V{sub 5}, V{sub 10}, V{sub 15}, and V{sub 20} were significantly associated with decreased WBC and ANC nadirs, as were female gender, decreased body mass index, and increased lumbosacral bone marrow V{sub 10}, V{sub 15}, and V{sub 20} (p < 0.05 for each association). Lymph node positivity was significantly associated with a decreased WBC nadir on multiple regression analysis (p < 0.05). Conclusion: This analysis supports the hypothesis that increased low-dose radiation to PBM is associated with acute HT during chemoradiotherapy for anal cancer. Techniques to limit bone marrow irradiation may reduce HT in anal cancer patients.

  7. Contrast-Enhanced [{sup 18}F]fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography for Staging and Radiotherapy Planning in Patients With Anal Cancer

    SciTech Connect

    Bannas, Peter; Weber, Christoph; Adam, Gerhard; Frenzel, Thorsten; Derlin, Thorsten; Mester, Janos; Klutmann, Susanne

    2011-10-01

    Purpose: The practice of surgical staging and treatment of anal cancer has been replaced by noninvasive staging and combined modality therapy. For appropriate patient management, accurate lymph node staging is crucial. The present study evaluated the feasibility and diagnostic accuracy of contrast-enhanced [{sup 18}F]fluoro-2-deoxy-D-glucose ([{sup 18}F]FDG)-positron emission tomography/computed tomography (PET/CT) for staging and radiotherapy planning of anal cancer. Methods and Materials: A total of 22 consecutive patients (median age, 61 years old) with anal cancer underwent complete staging evaluation including physical examination, biopsy of the primary tumor, and contrast-enhanced (ce)-PET/CT. Patients were positioned as they would be for their subsequent radiotherapy. PET and CT images were evaluated independently for detectability and localization of the primary tumor, pelvic and inguinal lymph nodes, and distant metastasis. The stage, determined by CT or PET alone, and the proposed therapy planning were compared with the stage and management determined by ce-PET/CT. Data from ce-PET/CT were used for radiotherapy planning. Results: ce-PET/CT revealed locoregional lymph node metastasis in 11 of 22 patients (50%). After simultaneous reading of PET and CT data sets by experienced observers, 3 patients (14%) were found to have sites of disease not seen on CT that were identified on PET. Two patients had sites of disease not seen on PET that were identified on CT. In summary, 2 patients were upstaged, and 4 patients were downstaged due to ce-PET/CT. However, radiotherapy fields were changed due to the results from ce-PET/CT in 23% of cases compared to CT or PET results alone. Conclusions: ce-PET/CT is superior to PET or CT alone for staging of anal cancer, with significant impact on therapy planning.

  8. Intensity-Modulated Radiation Therapy for Anal Malignancies: A Preliminary Toxicity and Disease Outcomes Analysis

    SciTech Connect

    Pepek, Joseph M.; Willett, Christopher G.; Wu, Q. Jackie; Yoo, Sua; Clough, Robert W.; Czito, Brian G.

    2010-12-01

    Purpose: Intensity-modulated radiation therapy (IMRT) has the potential to reduce toxicities associated with chemoradiotherapy in the treatment of anal cancer. This study reports the results of using IMRT in the treatment of anal cancer. Methods and Materials: Records of patients with anal malignancies treated with IMRT at Duke University were reviewed. Acute toxicity was graded using the NCI CTCAEv3.0 scale. Overall survival (OS), metastasis-free survival (MFS), local-regional control (LRC) and colostomy-free survival (CFS) were calculated using the Kaplan-Meier method. Results: Forty-seven patients with anal malignancy (89% canal, 11% perianal skin) were treated with IMRT between August 2006 and September 2008. Median follow-up was 14 months (19 months for SCC patients). Median radiation dose was 54 Gy. Eight patients (18%) required treatment breaks lasting a median of 5 days (range, 2-7 days). Toxicity rates were as follows: Grade 4: leukopenia (7%), thrombocytopenia (2%); Grade 3: leukopenia (18%), diarrhea (9%), and anemia (4%); Grade 2: skin (93%), diarrhea (24%), and leukopenia (24%). The 2-year actuarial overall OS, MFS, LRC, and CFS rates were 85%, 78%, 90% and 82%, respectively. For SCC patients, the 2-year OS, MFS, LRC, and CFS rates were 100%, 100%, 95%, and 91%, respectively. Conclusions: IMRT-based chemoradiotherapy for anal cancer results in significant reductions in normal tissue dose and acute toxicities versus historic controls treated without IMRT, leading to reduced rates of toxicity-related treatment interruption. Early disease-related outcomes seem encouraging. IMRT is emerging as a standard therapy for anal cancer.

  9. Combined preoperative neoadjuvant radiotherapy and chemotherapy for anal and rectal cancer

    SciTech Connect

    Smith, D.E.; Muff, N.S.; Shetabi, H.

    1986-05-01

    Neoadjuvant therapy combining 5-fluorouracil, mitomycin C, and moderate-dose radiotherapy was given preoperatively to 29 patients with adenocarcinoma of the rectum, 3 patients with squamous cell cancer, and 1 patient with basaloid carcinoma of the anus. Significant downstaging, and even eradication, of these lesions was realized in a high percentage of cases. Population-based data for the period of 1979 to 1984 which encompasses the time of our study indicate the survival of those treated by the neoadjuvant therapy was superior to that of patients treated by surgery alone or by surgery followed by radiotherapy. In general, patients with the poorest clinical presentation had been referred for this therapy.

  10. Mitomycin and Fluorouracil With Concurrent Radiation (FUMIR) Regimen for Anal Cancer

    PubMed Central

    White, Brittany N.; Waddell, J. Aubrey; Solimando, Dominic A.

    2013-01-01

    The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc, 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@aol.com; or J. Aubrey Waddell, Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, e-mail: waddfour@charter.net. PMID:24421505

  11. Evaluation of Planned Treatment Breaks During Radiation Therapy for Anal Cancer: Update of RTOG 92-08

    SciTech Connect

    Konski, Andre Garcia, Miguel; John, Madhu; Krieg, Richard; Pinover, Wayne; Myerson, Robert; Willett, Christopher

    2008-09-01

    Purpose: Radiation Therapy Oncology Group (RTOG) 92-08 began as a single arm, Phase II trial for patients with anal cancer consisting of radiation (RT) + 5-flourouracil + mitomycin-C with a mandatory 2-week break and was amended after completion to evaluate the same treatment regimen without a treatment break. Long-term efficacy and late toxicity reporting are the specific aims of this study. Methods and Materials: Survivals were estimated with the Kaplan-Meier method. Overall survival (OS) was compared with RTOG 87-04 with the log-rank test. Time to local failure, regional failure, locoregional failure (LRF), distant metastases, second primary, and colostomy failure were estimated by the cumulative incidence method. LRF was compared with RTOG 87-04 using the Gray's test. Results: Forty-seven patients entered in the mandatory treatment break cohort. The study was reopened in 1995 to the no mandatory treatment break cohort completing accrual with 20 patients in 1996. Of 67 total patients, 1 patient in the mandatory treatment break portion of the study did not receive any protocol treatment and is excluded from analyses. After adjusting for tumor size, neither cohort showed a statistically significant difference in OS or LRF compared with the RTOG 87-04 mitomycin-C arm. No patient in either cohort experienced a Grade 3 or higher late toxicity. Conclusions: No statistically significant differences were seen in OS or LRF when compared to the mitomycin-C arm of RTOG 87-04, but the sample sizes for the mandatory break cohort and the no mandatory break cohort are small. Late toxicity was low and similar for the treatment cohorts.

  12. Quality of Life in Patients Undergoing Radiation Therapy for Primary Lung Cancer, Head and Neck Cancer, or Gastrointestinal Cancer

    ClinicalTrials.gov

    2016-04-19

    Anal Cancer; Colorectal Cancer; Esophageal Cancer; Extrahepatic Bile Duct Cancer; Gallbladder Cancer; Gastric Cancer; Head and Neck Cancer; Liver Cancer; Lung Cancer; Pancreatic Cancer; Small Intestine Cancer

  13. Anal and perianal squamous carcinomas and high-grade intraepithelial lesions exclusively associated with "low-risk" HPV genotypes 6 and 11.

    PubMed

    Cornall, Alyssa M; Roberts, Jennifer M; Garland, Suzanne M; Hillman, Richard J; Grulich, Andrew E; Tabrizi, Sepehr N

    2013-11-01

    Anal squamous cell carcinomas are predominantly associated with high-risk human papillomaviruses (HPVs), particularly HPV 16, similar to cervical, vaginal and vulvar cancers. Although the presence of "low-risk" HPVs, in particular genotypes 6 and 11, have occasionally been reported in various HPV-related anogenital cancers, the overall distribution of these genotypes in the anal canal and perianal tissue may differ to that in the cervix. In addition, although the majority of anal and perianal cancers are associated with HPV, some are not; hence, confirmation of direct association of the virus within a lesion is important. Using laser capture microdissection, anal and perianal invasive carcinomas and high-grade squamous intraepithelial lesions (HSILs) in biopsies previously associated with HPV 6 or 11 alone were isolated from tissue sections and HPV genotype tested. Of seven cases tested, four invasive carcinomas were positive for HPV 6 only, one invasive carcinoma was negative for HPV and two HSILs were positive for HPV 11 only. All samples were confirmed as HPV 16/18 negative using two different DNA targets (E6 and L1). From these results, we confirm that HPV 6 and 11 can occasionally be associated with high-grade lesion and anal cancer.

  14. SU-E-J-270: Repeated 18F-FDG PET/CTs Based Feature Analysis for the Predication of Anal Cancer Recurrence

    SciTech Connect

    Wang, J; Chuong, M; Choi, W; Lu, W; Latifi, K; Saeed, N; Hoffe, S; Shridhar, R; Moros, E; Tan, S

    2015-06-15

    Purpose: To identify PET/CT based imaging predictors of anal cancer recurrence and evaluate baseline vs. mid-treatment vs. post-treatment PET/CT scans in the tumor recurrence prediction. Methods: FDG-PET/CT scans were obtained at baseline, during chemoradiotherapy (CRT, midtreatment), and after CRT (post-treatment) in 17 patients of anal cancer. Four patients had tumor recurrence. For each patient, the mid-treatment and post-treatment scans were respectively aligned to the baseline scan by a rigid registration followed by a deformable registration. PET/CT image features were computed within the manually delineated tumor volume of each scan to characterize the intensity histogram, spatial patterns (texture), and shape of the tumors, as well as the changes of these features resulting from CRT. A total of 335 image features were extracted. An Exact Logistic Regression model was employed to analyze these PET/CT image features in order to identify potential predictors for tumor recurrence. Results: Eleven potential predictors of cancer recurrence were identified with p < 0.10, including five shape features, five statistical texture features, and one CT intensity histogram feature. Six features were indentified from posttreatment scans, 3 from mid-treatment scans, and 2 from baseline scans. These features indicated that there were differences in shape, intensity, and spatial pattern between tumors with and without recurrence. Recurrent tumors tended to have more compact shape (higher roundness and lower elongation) and larger intensity difference between baseline and follow-up scans, compared to non-recurrent tumors. Conclusion: PET/CT based anal cancer recurrence predictors were identified. The post-CRT PET/CT is the most important scan for the prediction of cancer recurrence. The baseline and mid-CRT PET/CT also showed value in the prediction and would be more useful for the predication of tumor recurrence in early stage of CRT. This work was supported in part by the

  15. Comparison of Positron Emission Tomography Scanning and Sentinel Node Biopsy in the Detection of Inguinal Node Metastases in Patients With Anal Cancer

    SciTech Connect

    Mistrangelo, Massimiliano; Pelosi, Ettore; Bello, Marilena; Castellano, Isabella; Cassoni, Paola; Ricardi, Umberto; Munoz, Fernando; Racca, Patrizia; Contu, Viviana; Beltramo, Giancarlo; Morino, Mario; Mussa, Antonio

    2010-05-01

    Background: Inguinal lymph node metastases in patients with anal cancer are an independent prognostic factor for local failure and overall mortality. Inguinal lymph node status can be adequately assessed with sentinel node biopsy, and the radiotherapy strategy can subsequently be changed. We compared this technique vs. dedicated 18F-fluorodeoxyglucose positron emission tomography (PET) to determine which was the better tool for staging inguinal lymph nodes. Methods and Materials: In our department, 27 patients (9 men and 18 women) underwent both inguinal sentinel node biopsy and PET-CT. PET-CT was performed before treatment and then at 1 and 3 months after treatment. Results: PET-CT scans detected no inguinal metastases in 20 of 27 patients and metastases in the remaining 7. Histologic analysis of the sentinel lymph node detected metastases in only three patients (four PET-CT false positives). HIV status was not found to influence the results. None of the patients negative at sentinel node biopsy developed metastases during the follow-up period. PET-CT had a sensitivity of 100%, with a negative predictive value of 100%. Owing to the high number of false positives, PET-CT specificity was 83%, and positive predictive value was 43%. Conclusions: In this series of patients with anal cancer, inguinal sentinel node biopsy was superior to PET-CT for staging inguinal lymph nodes.

  16. Treatment of anal fistula and abscess.

    PubMed

    Pigot, F

    2015-04-01

    The glands of Hermann and Desfosses, located in the thickness of the anal canal, drain into the canal at the dentate line. Infection of these anal glands is responsible for the formation of abscesses and/or fistulas. When this presents as an abscess, emergency drainage of the infected cavity is required. At the stage of fistula, treatment has two sometimes conflicting objectives: effective drainage and preservation of continence. These two opposing constraints explain the existence of two therapeutic concepts. On one hand the laying-open of the fistulous tract (fistulotomy) in one or several operative sessions remains the treatment of choice because of its high cure rates. On the other hand surgical closure with tract ligation or obturation with biological components preserves sphincter function but suffers from a higher failure rate.

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

    PubMed Central

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

    2017-01-01

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

  18. 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

  19. 'Mind the Gap'-The Impact of Variations in the Duration of the Treatment Gap and Overall Treatment Time in the First UK Anal Cancer Trial (ACT I)

    SciTech Connect

    Glynne-Jones, Rob; Sebag-Montefiore, David; Adams, Richard; McDonald, Alec; Gollins, Simon; James, Roger; Northover, John M.A.; Meadows, Helen M.; Jitlal, Mark

    2011-12-01

    Purpose: The United Kingdom Coordinating Committee on Cancer Research anal cancer trial demonstrated the benefit of combined modality treatment (CMT) using radiotherapy (RT), infusional 5-fluorouracil, and mitomycin C over RT alone. The present study retrospectively examines the impact of the recommended 6-week treatment gap and local RT boost on long-term outcome. Methods and Materials: A total of 577 patients were randomly assigned RT alone or CMT. After a 6-week gap responders received a boost using either additional external beam radiotherapy (EBRT) (15 Gy) or iridium-192 implant (25 Gy). The effect of boost, the gap between initial treatment (RT alone or CMT) and boost (Tgap), and overall treatment time (OTT) were examined for their impact on outcome. Results: Among the 490 good responders, 436 (89%) patients received a boost after initial treatment. For boosted patients, the risk of anal cancer death decreased by 38% (hazard ratio [HR]: 0.62, 99% CI 0.35-1.12; p = 0.04), but there was no evidence this was mediated via a reduction in locoregional failure (LRF) (HR: 0.90, 99% CI 0.48-1.68; p = 0.66). The difference in Tgap was only 1.4 days longer for EBRT boost, compared with implant (p = 0.51). OTT was longer by 6.1 days for EBRT (p = 0.006). Tgap and OTT were not associated with LRF. Radionecrosis was reported in 8% of boosted, compared with 0% in unboosted patients (p = 0.03). Conclusions: These results question the benefit of a radiotherapy boost after a 6-week gap. The higher doses of a boost may contribute more to an increased risk of late morbidity, rather than local control.

  20. Anal Health Care Basics

    PubMed Central

    Chang, Jason; McLemore, Elisabeth; Tejirian, Talar

    2016-01-01

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

  1. Anal Health Care Basics.

    PubMed

    Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar

    2016-01-01

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

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

    PubMed

    Singh, Siddharth; Verma, Satyajeet; Kala, Sanjay

    2014-01-01

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

  3. Outcomes of Chemoradiotherapy With 5-Fluorouracil and Mitomycin C for Anal Cancer in Immunocompetent Versus Immunodeficient Patients

    SciTech Connect

    Seo, Yuji; Kinsella, Michael T.; Reynolds, Harry L.; Chipman, Gregory; Remick, Scot C.; Kinsella, Timothy J.

    2009-09-01

    Purpose: Information is limited as to how we should treat invasive anal squamous cell carcinoma (SCC) in patients with chronic immunosuppression, since the majority of clinical studies to date have excluded such patients. The objective of this study is to compare treatment outcomes in immunocompetent (IC) versus immunodeficient (ID) patients with invasive anal SCC treated similarly with combined modality therapy. Methods and Materials: Between January 1999 and March 2007, a total of 36 consecutive IC and ID patients received concurrent chemoradiotherapy using three-dimensional conformal radiotherapy with infusional 5-fluorouracil and mitomycin C. The IC and ID groups consisted of 19 and 17 patients, respectively, with 14 human immunodeficiency virus-positive (HIV+) and 3 post-solid organ transplant ID patients. There were no significant differences in tumor size, T stage, N stage, chemotherapy doses, or radiation doses between the two groups. Results: With a median follow-up of 3.1 years, no differences were found in overall survival, disease-specific survival, and colostomy-free survival. Three-year overall survival was 83.6% (95% CI = 68.2-100) and 91.7% (95% CI = 77.3-100) in the IC and ID groups, respectively. In addition, there were no differences in acute and late toxicity profiles between the two groups. In the human immunodeficiency virus-positive patients, Cox modeling showed no difference in overall survival by pretreatment CD4 counts (hazard ratio = 0.994, 95% CI = 0.98-1.01). No correlation was found between CD4 counts and the degree of acute toxicities. Conclusion: Our data suggest that standard combined modality therapy with three-dimensional conformal radiotherapy and 5-fluorouracil plus mitomycin C is as safe and effective for ID patients as for IC patients.

  4. 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.

  5. Optical spectroscopy diagnosis for serum of normal and digestive canal cancer

    NASA Astrophysics Data System (ADS)

    Li, Xiaozhou; Jin, Huiqiang; Wang, Yuepeng

    2003-07-01

    To investigate the spectral specialities of digestive cancer serum for diagnosis, fluorescence and Raman spectra of normal, digestive cancer (both before and after operation), such as stomach cancer, esophagus cancer and atrophic gastritis sera were measured in the visible region in this study. Results demonstrate several points. First, all spectra except esophagus cancer were characterized by three sharp peaks (A, B and C), but we cannot differentiate them from each other at once. The intensity of each peak was different in different spectrum. Second, after samples were radiated by laser, fluorescence weakend along with red shift of its band center, and spectral changes of normal and stomach cancer (after operation) cases were different from other samples. It was also observed that spectral changes of atrophic gastritis were very similar with stomach cancer (such as the red shift of fluorescence peak is more than 12 nm) after radiated by laser, however, there are still some distinctions that can be used to differentiate them from each other. At last, a notable difference is that the relative intensity of peak C excited by 488.0 nm is higher than excited by 514.5 nm in spectrum of stomach cancer, whereas lower in other cases.

  6. Oxaliplatin Plus Irinotecan in Treating Patients With Metastatic Gastrointestinal Cancer

    ClinicalTrials.gov

    2013-06-24

    Anal Cancer; Colorectal Cancer; Esophageal Cancer; Extrahepatic Bile Duct Cancer; Gallbladder Cancer; Gastric Cancer; Gastrointestinal Carcinoid Tumor; Liver Cancer; Pancreatic Cancer; Small Intestine Cancer

  7. Anal abscess and fistula.

    PubMed

    Sneider, Erica B; Maykel, Justin A

    2013-12-01

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

  8. Ascending and descending reflex motor activity of recto-anal region-cholinergic and nitrergic implications in a rat model.

    PubMed

    Radomirov, Radomir; Ivancheva, Christina; Brading, Alison F; Itzev, Dimitar; Rakovska, Angelina; Negrev, Negrin

    2009-04-29

    The implications of cholinergic and nitrergic transmissions in ascending and descending reflex motor pathways of recto-anal region in rat model were evaluated using: (i) electrical stimulation; (ii) triple organ bath; and (iii) morphological techniques. Electrical stimulation to anal canal induced simultaneous ascending contractile responses of longitudinal and circular muscles of proximal rectum, local contraction of anal canal or contraction followed by relaxation of internal anal sphincter when external sphincter was dissected off. The stimulation of proximal rectum elicited local contractions of both rectal layers and descending contractions of internal sphincter or anal canal. Tetrodotoxin (0.1 microM) prevented the electrically elicited events. The ascending excitatory responses and the local and ascending contractions of longitudinal muscle were more pronounced than those of circular muscle suggesting dominant role of ascending reflex pathways and of longitudinal muscle in rectal motor activity. Choline acetyltransferase (ChAT)-containing fibres and nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase-positive neurons were observed in myenteric ganglia of rectum and anal canal. NG-nitro-l-arginine (0.5mM) increased the contractile ascending and descending responses. During atropine (0.3 microM) treatment the ascending and descending contractions were suppressed but not abolished and a relaxation revealed in ascending response of circular muscle and in descending responses of internal anal sphincter and anal canal. The relaxation was decreased by NG-nitro-l-arginine and increased by l-arginine (0.5mM). The results suggest that cholinergic excitatory ascending and descending pathways and nitric oxide-dependent inhibitory ascending neurotransmission(s) to rectal circular muscle and inhibitory descending to internal anal sphincter and anal canal are involved in reflex circuitry controlling motor activity of recto-anal region.

  9. 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

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

    PubMed

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

    2009-03-01

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

  11. Anal fissure - slideshow

    MedlinePlus

    ... anatomy URL of this page: //medlineplus.gov/ency/presentations/100154.htm Anal fissure - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 4 Go to slide 2 ...

  12. [Acute anal pain].

    PubMed

    Pittet, O; Demartines, N; Hahnloser, D

    2014-03-05

    Anal pain is a common reason for consultation, whose etiology is varied and should not be limited to the hemorrhoidal disease. The purpose of this article is to conduct a review of the literature on anorectal pathologies most frequently encountered and make recommendations regarding their management.

  13. Anal Neuroendocrine Tumor Masquerading as External Hemorrhoids: A Case Report

    PubMed Central

    Khan, Muhammad; Dirweesh, Ahmed; Alvarez, Chikezie; Conaway, Herbert; Moser, Robert

    2017-01-01

    Neuroendocrine tumors in gastrointestinal (GI) tract are a rare source of GI malignancy with an estimated incidence of 2.5 - 5 per 100,000 people per year and the prevalence of 35 per 100,000. In the GI tract, they are located in decreasing order of frequency in appendix, ileum, rectum, stomach, and colon. Those found in the anal region represent just 1% of all malignancies of the anal canal. Their clinical presentation can be widely varying, sometimes being found incidentally with metastatic disease and an unknown primary source. We report a case of a 60-year-old male who presented with a 2-week history of intermittent bright red blood per rectum and anal pain. He was found to have a lesion in the perianal area which was subsequently diagnosed has a poorly differentiated large cell type neuroendocrine carcinoma (NEC) with hepatic metastasis. PMID:28270879

  14. 3. ELEVATION. FROM SOUTH WITH CANAL PRISM. Canal Road ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. ELEVATION. FROM SOUTH WITH CANAL PRISM. - Canal Road Bridge, Canal Road spanning Delaware Canal Diversion, Locks 22 & 23 in Delaware Canal State Park in Williams Township, Raubsville, Northampton County, PA

  15. Controversy at Love Canal.

    PubMed

    Paigen, B

    1982-06-01

    A cancer researcher reviews the events surrounding the toxic waste contamination at Love Canal with emphasis on the political nature of the controversy about its health impact. Antagonism between the community and the New York State Department of Health was fueled by several factors: the state's awareness that it gained from delay in investigation, disagreement on health problems to be studied, control over the information gathering process, silencing of opposition opinion, and the violation of norms of scientific behavior. The author calls for the establishment of standards of ethical behavior for scientists in such situations, standards for conflict resolution, and means of appeal for those injured.

  16. Cancer in Patients With Gabapentin (GPRD)

    ClinicalTrials.gov

    2012-02-02

    Pain, Neuropathic; Epilepsy; Renal Pelvis Cancer; Pancreatic Cancer; Breast Cancer; Nervous System Cancer; Chronic Pancreatitis; Stomach Cancer; Renal Cell Carcinoma; Diabetes; Bladder Cancer; Bone and Joint Cancer; Penis Cancer; Anal Cancer; Cancer; Renal Cancer

  17. Collection of Biospecimen & Clinical Information in Patients w/ Gastrointestinal Cancers

    ClinicalTrials.gov

    2012-05-24

    Gastrointestinal Neoplasms; Gynecologic Cancers; Gynecologic Cancers Cervical Cancer; Gastric (Stomach) Cancer; Gastro-Esophageal(GE) Junction Cancer; Gastrointenstinal Stromal Tumor (GIST); Colon/Rectal Cancer; Colon/Rectal Cancer Colon Cancer; Colon/Rectal Cancer Rectal Cancer; Colon/Rectal Cancer Anal Cancer; Anal Cancer; Hepatobiliary Cancers; Hepatobiliary Cancers Liver; Pancreatic Cancer

  18. [Cryptoglandular anal fistulas].

    PubMed

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

    2008-10-31

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

  19. Anal involvement in pemphigus vularis.

    PubMed

    Khezri, Somayeh; Mahmoudi, Hamid-Reza; Masoom, Seyedeh Nina; Daneshpazhooh, Maryam; Balighi, Kamran; Hosseini, S Hamed; Chams-Davatchi, Cheyda

    2013-01-01

    Background. Pemphigus vulgaris (PV) is an autoimmune blistering disease of the skin and mucosa. Anal mucosa may be involved in PV, but the frequency and clinical profile are not fully ascertained. Objective. The aim was to investigate the involvement of the anal area in newly diagnosed PV patients. Patients and Methods. A total of 168 consecutive newly diagnosed PV patients were enrolled. Anal symptoms and signs, involvement of other body sites, and severity of disease were recorded. Results. A total of 47 out of 168 patients (27.9%) had involvement of the anal area. Anal involvement was significantly associated with PV lesions in ophthalmic (P = 0.03), nasal (P = 0.02), and genital mucosa (P < 0.001) but not the oral cavity (P = 0.24). There was a significant association between number of involved mucosal sites and anal involvement (P < 0.001). Anal involvement was associated with oral severity (P = 0.02). Constipation was the most frequent symptom (73.8%) followed by pain on defecation (50%). Seventeen patients (36%) were symptom-free. Erosion was the most frequent sign (91.5%). Conclusion. Anal involvement in PV seems to be more frequent than previously assumed. Routine anal examination is recommended even in asymptomatic patients as anal involvement appears to correlate with the severity of PV.

  20. SU-E-J-254: Evaluating the Role of Mid-Treatment and Post-Treatment FDG-PET/CT in Predicting Progression-Free Survival and Distant Metastasis of Anal Cancer Patients Treated with Chemoradiotherapy

    SciTech Connect

    Zhang, H; Wang, J; Chuong, M; D’Souza, W; Choi, W; Lu, W; Latifi, K; Hoffe, S; Moros, E; Saeed, Nadia; Tan, S; Shridhar, R

    2015-06-15

    Purpose: To evaluate the role of mid-treatment and post-treatment FDG-PET/CT in predicting progression-free survival (PFS) and distant metastasis (DM) of anal cancer patients treated with chemoradiotherapy (CRT). Methods: 17 anal cancer patients treated with CRT were retrospectively studied. The median prescription dose was 56 Gy (range, 50–62.5 Gy). All patients underwent FDG-PET/CT scans before and after CRT. 16 of the 17 patients had an additional FDG-PET/CT image at 3–5 weeks into the treatment (denoted as mid-treatment FDG-PET/CT). 750 features were extracted from these three sets of scans, which included both traditional PET/CT measures (SUVmax, SUVpeak, tumor diameters, etc.) and spatialtemporal PET/CT features (comprehensively quantify a tumor’s FDG uptake intensity and distribution, spatial variation (texture), geometric property and their temporal changes relative to baseline). 26 clinical parameters (age, gender, TNM stage, histology, GTV dose, etc.) were also analyzed. Advanced analytics including methods to select an optimal set of predictors and a model selection engine, which identifies the most accurate machine learning algorithm for predictive analysis was developed. Results: Comparing baseline + mid-treatment PET/CT set to baseline + posttreatment PET/CT set, 14 predictors were selected from each feature group. Same three clinical parameters (tumor size, T stage and whether 5-FU was held during any cycle of chemotherapy) and two traditional measures (pre- CRT SUVmin and SUVmedian) were selected by both predictor groups. Different mix of spatial-temporal PET/CT features was selected. Using the 14 predictors and Naive Bayes, mid-treatment PET/CT set achieved 87.5% accuracy (2 PFS patients misclassified, all local recurrence and DM patients correctly classified). Post-treatment PET/CT set achieved 94.0% accuracy (all PFS and DM patients correctly predicted, 1 local recurrence patient misclassified) with logistic regression, neural network or

  1. Dysregulation of Autophagy Contributes to Anal Carcinogenesis

    PubMed Central

    Carchman, Evie H.; Matkowskyj, Kristina A.; Meske, Louise; Lambert, Paul F.

    2016-01-01

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

  2. Long-Term Follow-Up of a Phase II Trial of High-Dose Radiation With Concurrent 5-Fluorouracil and Cisplatin in Patients With Anal Cancer (ECOG E4292)

    SciTech Connect

    Chakravarthy, A. Bapsi; Catalano, Paul J.; Martenson, James A.; Mondschein, Joshua K.; Wagner, Henry; Mansour, Edward G.; Talamonti, Mark S.; Benson, Al Bowen

    2011-11-15

    Purpose: Although chemoradiation using 5-fluorouracil (5-FU) and mitomycin-C (MMC) is the standard of care in the treatment of anal cancer, many patients are unable to tolerate MMC. This Phase II clinical trial was performed to determine whether cisplatin could replace MMC in the treatment of anal cancer. Methods and Materials: Thirty-three patients with localized anal cancer were enrolled. One patient registered but never received any assigned therapy and was excluded from all analyses. Between February 1, 1993, and July 21, 1993, 19 patients were accrued to Cohort 1. Radiation consisted of 45 Gy to the primary tumor and pelvic nodes, followed by a boost to the primary and involved nodes to 59.4 Gy. A planned 2-week treatment break was used after 36 Gy. Concurrent chemotherapy consisted of 5-FU 1,000 mg/m{sup 2}/day on Days 1 to 4 and cisplatin 75 mg/m{sup 2} on Day 1. A second course of 5-FU and cisplatin was given after 36 Gy, when the patient resumed radiation therapy. Between April 4, 1996, and September 23, 1996, an additional 13 patients (Cohort 2) were accrued to the study and received the same treatment except without the planned treatment break. Results: Complete response was seen in 78% (90% CI, 63-89) of patients and was higher in patients who did not get a planned treatment break (92% vs. 68%). The overall Grade 4 toxicity rate was 31%. One treatment-related death (Grade 5) occurred in a patient who developed sepsis. The 5-year overall survival was 69%. Conclusions: Radiation therapy, cisplatin, and 5-FU resulted in an overall objective response (complete response + partial response) of 97%. Although the 5-year progression-free survival was only 55%, the overall 5-year survival was 69%. Given the excellent salvage provided by surgery, this study affirms that cisplatin-based regimens may be an alternative for patients who cannot tolerate the severe hematologic toxicities associated with mitomycin-based chemoradiation regimens.

  3. 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

  4. Management of Complex Anal Fistulas

    PubMed Central

    Bubbers, Emily J.; Cologne, Kyle G.

    2016-01-01

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

  5. Atrioventricular Canal Defect

    MedlinePlus

    ... al. Clinical manifestations, pathophysiology, and diagnosis of atrioventricular (AV) canal defects. http://www.uptodate.com/home. Accessed ... CE, et al. Management and outcome of atrioventricular (AV) canal defects. http://www.uptodate.com/home. Accessed ...

  6. [Perianal fistula and anal fissure].

    PubMed

    Heitland, W

    2012-12-01

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

  7. Total proctocolectomy and ileal - anal pouch

    MedlinePlus

    Restorative proctocolectomy; Ileal-anal resection; Ileal-anal pouch; J-pouch; S-pouch; Pelvic pouch; Ileal-anal pouch; Ileal ... RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, ...

  8. [Surgical treatment of anal fistula].

    PubMed

    Zeng, Xiandong; Zhang, Yong

    2014-12-01

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

  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.

  10. 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.

  11. Modern management of anal fistula.

    PubMed

    Limura, Elsa; Giordano, Pasquale

    2015-01-07

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

  12. Root canal irrigants

    PubMed Central

    Kandaswamy, Deivanayagam; Venkateshbabu, Nagendrababu

    2010-01-01

    Successful root canal therapy relies on the combination of proper instrumentation, irrigation, and obturation of the root canal. Of these three essential steps of root canal therapy, irrigation of the root canal is the most important determinant in the healing of the periapical tissues. The primary endodontic treatment goal must thus be to optimize root canal disinfection and to prevent reinfection. In this review of the literature, various irrigants and the interactions between irrigants are discussed. We performed a Medline search for English-language papers published untill July 2010. The keywords used were ‘root canal irrigants’ and ‘endodontic irrigants.’ The reference lists of each article were manually checked for additional articles of relevance. PMID:21217955

  13. 14. Junction of the Tempe Canal and Western Canal, looking ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    14. Junction of the Tempe Canal and Western Canal, looking north. Photographer: Mark Durben, February 1989. Source: SRPA - Tempe Canal, South Side Salt River in Tempe, Mesa & Phoenix, Tempe, Maricopa County, AZ

  14. Bitter Root Irrigation district canal, looking east, typical section (canal ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Bitter Root Irrigation district canal, looking east, typical section (canal full) - Bitter Root Irrigation Project, Bitter Root Irrigation Canal, Heading at Rock Creek Diversion Dam, West of U.S. Highway 93, Darby, Ravalli County, MT

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

    PubMed Central

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

    2015-01-01

    Abstract Identifying factors, including human papillomavirus (HPV) genotypes, associated with abnormal anal cytology in HIV-infected women have implications for anal squamous cell cancer (SCC) prevention in HIV-infected women. Anal and cervical samples were collected for cytology, and tested for high-(HR-HPV) and low-risk HPV (LR-HPV) genotypes in a cross-sectional analysis of the IPEC Women's HIV Cohort (Rio de Janeiro, Brazil). Multivariate log-binomial regression models estimated prevalence ratios for factors associated with abnormal anal cytology [≥atypical squamous cells of undetermined significance, (ASC-US)]. Characteristics of the 863 participants included: median age 42 years, 57% non-white, 79% current CD4+ T-cell count >350 cells/mm3, 53% HIV-1 viral load <50 copies/mL, median ART duration 5.8 years. Fifty-one percent of anal specimens contained ≥1 HR-HPV genotype; 31% had abnormal anal cytology [14% ASC-US, 11% low-grade squamous intra-epithelial lesion, (LSIL); 2% atypical squamous cells-cannot exclude high-grade SIL (ASC-H); 4% high-grade SIL/cancer (HSIL+)]. In multivariate analysis, cervical LSIL+, nadir CD4+ T-cell count ≤50 cells/mm3, HIV-1 viral load ≥50 copies/mL, and anal HPV 6, 11, 16, 18, 33, 45, 52, 56, and 58 were associated with ≥anal ASC-US (p<0.05). Abnormal anal cytology and HR-HPV prevalences were high. HIV-infected women with cervical LSIL+, low nadir CD4+ counts, or detectable HIV-1 viral loads should be a particular focus for enhanced anal SCC screening efforts. PMID:25361401

  16. 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

  17. Anal fistula. Past and present.

    PubMed

    Zubaidi, Ahmad M

    2014-09-01

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

  18. Videoscopic Versus Open Inguinal Lymphadenectomy for Cancer

    ClinicalTrials.gov

    2015-05-04

    Melanoma; Merkel Cell Carcinoma; Squamous Cell Carcinoma; Penile Carcinoma; Urethral Carcinoma; Extramammary Paget's Disease; Scrotal Carcinoma; Anal Cancer; Vulvar Cancer; Skin Cancer; Lymphadenopathy

  19. Bush Canal Floodgate Study

    DTIC Science & Technology

    2009-07-01

    ER D C/ CH L TR -0 9 -9 Bush Canal Floodgate Study Tate O. McAlpin, Rutherford C. Berger, and Amena M. Henville July 2009 C oa st...al a n d H yd ra u lic s La b or at or y Approved for public release; distribution is unlimited. ERDC/CHL TR-09-9 July 2009 Bush Canal ...LA 70118-3651 Under Military Interdepartmental Purchase Request (MIPR) W42HEM60734548, “H&H Modeling of Bush Canal /Morganza to the Gulf” ERDC/CHL

  20. Cancer Research Repository for Individuals With Cancer Diagnosis, High Risk Individuals, and Individuals With No History of Cancer (Control)

    ClinicalTrials.gov

    2016-11-14

    Pancreatic Cancer; Thyroid Cancer; Lung Cancer; Esophageal Cancer; Thymus Cancer; Colon Cancer; Rectal Cancer; GIST; Anal Cancer; Bile Duct Cancer; Duodenal Cancer; Gallbladder Cancer; Gastric Cancer; Liver Cancer; Small Intestine Cancer; Peritoneal Surface Malignancies; Familial Adenomatous Polyposis; Lynch Syndrome; Bladder Cancer; Kidney Cancer; Penile Cancer; Prostate Cancer; Testicular Cancer; Ureter Cancer; Urethral Cancer; Hypopharyngeal Cancer; Laryngeal Cancer; Lip Cancer; Oral Cavity Cancer; Nasopharyngeal Cancer; Oropharyngeal Cancer; Paranasal Sinus Cancer; Nasal Cavity Cancer; Salivary Gland Cancer; Skin Cancer; CNS Tumor; CNS Cancer; Mesothelioma; Breastcancer; Leukemia; Melanoma; Sarcoma; Unknown Primary Tumor; Multiple Myeloma; Ovarian Cancer; Endometrial Cancer; Vaginal Cancer

  1. Puborectal sling interposition combined with seton drainage for pouch-vaginal fistula after rectal cancer surgery with colonic J pouch-anal reconstruction: report of a case.

    PubMed

    Kawamoto, Aya; Inoue, Yasuhiro; Okigami, Masato; Okugawa, Yoshinaga; Hiro, Junichiro; Toiyama, Yuji; Tanaka, Koji; Uchida, Keiichi; Mohri, Yasuhiko; Kusunoki, Masato

    2014-01-01

    The management of postoperative rectovaginal fistula (RVF) after rectal cancer surgery is difficult and requires reconstruction of the anastomotic site and fistula. Though various surgical procedures have been reported for the repair of RVFs, the results of surgical repair are often unsatisfactory, and failure of the initial repair leads to difficulty in the later operations. Furthermore, it has been reported that cases associated with local infection result in low success rates. We report a case of an 80-year-old woman with a recurrent colonic J pouch-vaginal fistula after anoabdominal rectal resection with partial internal sphincteric resection, who achieved a good outcome following a repair using a puborectal sling interposition combined with seton drainage. It may be a useful option for RVF management in repair of such pouch-vaginal fistula after coloanal anastomosis with intersphincteric resection.

  2. Irinotecan, Fluorouracil, and Leucovorin in Treating Patients With Advanced Gastrointestinal Cancer

    ClinicalTrials.gov

    2016-04-19

    Anal Cancer; Carcinoma of the Appendix; Colorectal Cancer; Esophageal Cancer; Extrahepatic Bile Duct Cancer; Gallbladder Cancer; Gastric Cancer; Gastrointestinal Carcinoid Tumor; Gastrointestinal Stromal Tumor; Liver Cancer; Pancreatic Cancer; Small Intestine Cancer

  3. Panama Canal capacity analysis

    SciTech Connect

    Bronzini, M.S.

    1995-04-27

    Predicting the transit capacities of the various Panama Canal alternatives required analyzing data on present Canal operations, adapting and extending an existing computer simulation model, performing simulation runs for each of the alternatives, and using the simulation model outputs to develop capacity estimates. These activities are summarized in this paper. A more complete account may be found in the project final report (TAMS 1993). Some of the material in this paper also appeared in a previously published paper (Rosselli, Bronzini, and Weekly 1994).

  4. SU-D-9A-02: Relative Effects of Threshold Choice and Spatial Resolution Modeling On SUV and Volume Quantification in F18-FDG PET Imaging of Anal Cancer Patients

    SciTech Connect

    Zhao, F; Bowsher, J; Palta, M; Czito, B; Willett, C; Yin, F

    2014-06-01

    Purpose: PET imaging with F18-FDG is utilized for treatment planning, treatment assessment, and prognosis. A region of interest (ROI) encompassing the tumor may be determined on the PET image, often by a threshold T on the PET standard uptake values (SUVs). Several studies have shown prognostic value for relevant ROI properties including maximum SUV value (SUVmax), metabolic tumor volume (MTV), and total glycolytic activity (TGA). The choice of threshold T may affect mean SUV value (SUVmean), MTV, and TGA. Recently spatial resolution modeling (SRM) has been introduced on many PET systems. SRM may also affect these ROI properties. The purpose of this work is to investigate the relative influence of SRM and threshold choice T on SUVmean, MTV, TGA, and SUVmax. Methods: For 9 anal cancer patients, 18F-FDG PET scans were performed prior to treatment. PET images were reconstructed by 2 iterations of Ordered Subsets Expectation Maximization (OSEM), with and without SRM. ROI contours were generated by 5 different SUV threshold values T: 2.5, 3.0, 30%, 40%, and 50% of SUVmax. Paired-samples t tests were used to compare SUVmean, MTV, and TGA (a) for SRM on versus off and (b) between each pair of threshold values T. SUVmax was also compared for SRM on versus off. Results: For almost all (57/60) comparisons of 2 different threshold values, SUVmean, MTV, and TGA showed statistically significant variation. For comparison of SRM on versus off, there were no statistically significant changes in SUVmax and TGA, but there were statistically significant changes in MTV for T=2.5 and T=3.0 and in SUVmean for all T. Conclusion: The near-universal statistical significance of threshold choice T suggests that, regarding harmonization across sites, threshold choice may be a greater concern than choice of SRM. However, broader study is warranted, e.g. other iterations of OSEM should be considered.

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

    PubMed

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

    2016-01-01

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

  6. Successful hepatectomy for metastatic squamous cell carcinoma of the anal canal—a case report

    PubMed Central

    Sousa, Tercia Tarciane; Belotto, Marcos; Peixoto, Renata D’Alpino

    2016-01-01

    Despite rare, metastatic anal carcinoma confers a poor prognosis. Systemic chemotherapy is the mainstay of treatment for advanced disease while the role of biologics and/or surgical resection of metastatic disease are anecdotal. Compared to isolated liver colorectal or neuroendocrine cancer liver metastases, there is far less experience with resection or nonsurgical local ablative procedures for patients with metastatic anal carcinoma to the liver. We report the case of a 67-year-old woman with metastatic anal carcinoma to the liver who was successfully treated with liver resection and remains free of relapse more than one year later. PMID:28078133

  7. The Semicircular Canal Microphonic

    NASA Technical Reports Server (NTRS)

    Rabbitt, R. D.; Boyle, R.; Highstein, S. M.; Dalton, Bonnie P. (Technical Monitor)

    2002-01-01

    Present experiments were designed to quantify the alternating current (AC) component of the semicircular canal microphonic for angular motion stimulation as a function of stimulus frequency and amplitude. The oyster toadfish, Opsanus tau, was used as the experimental model. Calibrated mechanical indentation of the horizontal canal duct was used as a stimulus to generate hair-cell and afferent responses reproducing those present during head rotation. Sensitivity to polarization of the endolymph DC voltage re: perilymph was also investigated. Modulation of endolymph voltage was recorded using conventional glass electrodes and lock-in amplification over the frequency range 0.2-80 Hz. Access to the endolymph for inserting voltage recording and current passing electrodes was obtained by sectioning the anterior canal at its apex and isolating the cut ends in air. For sinusoidal stimulation below approx.10 Hz, the horizontal semicircular canal AC microphonic was nearly independent of stimulus frequency and equal to approximately 4 microV per micron indent (equivalent to approx. 1 microV per deg/s). A saturating nonlinearity decreasing the microphonic gain was present for stimuli exceeding approx.3 micron indent (approx. 12 deg/s angular velocity). The phase was not sensitive to the saturating nonlinearity. The microphonic exhibited a resonance near 30Hz consistent with basolateral current hair cell resonance observed previously in voltage-clamp records from semicircular canal hair cells. The magnitude and phase of the microphonic exhibited sensitivity to endolymphatic polarization consistent with electro-chemical reversal of hair cell transduction currents.

  8. Palonosetron Hydrochloride in Preventing Nausea and Vomiting Caused by Radiation Therapy in Patients With Primary Abdominal Cancer

    ClinicalTrials.gov

    2016-12-07

    Anal Cancer; Carcinoma of the Appendix; Colorectal Cancer; Extrahepatic Bile Duct Cancer; Gallbladder Cancer; Gastric Cancer; Gastrointestinal Carcinoid Tumor; Liver Cancer; Nausea and Vomiting; Pancreatic Cancer; Primary Peritoneal Cavity Cancer; Small Intestine Cancer

  9. 55. View of junction of unlined canal and lined canal, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    55. View of junction of unlined canal and lined canal, looking southwest. Photo by Brian C. Morris, Puget Power, 1989. - Puget Sound Power & Light Company, White River Hydroelectric Project, 600 North River Avenue, Dieringer, Pierce County, WA

  10. 54. View of junction of unlined canal and lined canal, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    54. View of junction of unlined canal and lined canal, looking southwest. Photo by Brian C. Morris, Puget Power, 1989. - Puget Sound Power & Light Company, White River Hydroelectric Project, 600 North River Avenue, Dieringer, Pierce County, WA

  11. 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.

  12. 56. View of lined canal looking east toward unlined canal, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    56. View of lined canal looking east toward unlined canal, from road bridge crossing lined canal. Photo by Brian C. Morris, Puget Power, 1989. - Puget Sound Power & Light Company, White River Hydroelectric Project, 600 North River Avenue, Dieringer, Pierce County, WA

  13. Love canal questions

    NASA Astrophysics Data System (ADS)

    Bell, Peter M.

    The Environmental Protection Agency (EPA) conducted a 3-month monitoring study of the Love Canal area near Niagara Falls, N.Y., after the federal government pronounced that a potential health risk existed due to chemical waste dumps. In 1982 the Department of Health and Human Services (HHS) decided that the area was habitable, subject to implementation of effective safeguards against leakage from the canal and to cleaning up of the contaminants. Now, the Congressional Office of Technology Assessment (OTA) has announced that, with the information available, it is not possible to demonstrate with certainty that unsafe levels do not exist within the so-called “emergency declaration area” (EDA).

  14. The presence of bovine papillomavirus type 4 DNA is not required for the progression to, or the maintenance of, the malignant state in cancers of the alimentary canal in cattle.

    PubMed

    Campo, M S; Moar, M H; Sartirana, M L; Kennedy, I M; Jarrett, W F

    1985-07-01

    In the Western Highlands of Scotland there is a very high incidence of alimentary cancers in cattle. The carcinomas of the upper alimentary canal are found in association with virus-induced benign papillomas, and transformation of papillomas to carcinomas has been observed. Strong circumstantial evidence suggests that the progression to malignancy is due to the interplay between the virus, bovine papillomavirus type 4 (BPV-4), and carcinogen(s) present in bracken fern, which infests the marginal upland grazing grounds. The carcinomas are often accompanied by adenomas and adenocarcinomas of the lower bowels. To elucidate the role of the virus in the transformation process, we have analysed several malignancies of the alimentary canal, and have detected the viral genome in only one case of transforming papilloma of the oesophagus and one case of carcinoma of the tongue. We conclude that, although required for the induction of papillomas, the presence of the BPV-4 DNA is not necessary for the progression to, or the maintenance of, the transformed state.

  15. Anal fistula: intraoperative difficulties and unexpected findings.

    PubMed

    Abou-Zeid, Ahmed A

    2011-07-28

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

  16. Treatment of anal human papillomavirus-associated disease: a long term outcome study.

    PubMed

    Nathan, M; Hickey, N; Mayuranathan, L; Vowler, S L; Singh, N

    2008-07-01

    Treatment for human papillomavirus (HPV)-associated anal canal disease has been unsatisfactory. The objective of our study was to determine the treatment outcome in our cohort with anal HPV disease. Overall, 181 patients were evaluated over a median period of 19.1 months (range = 2.8-125.5). Eighty-eight patients (48.6%) with high-grade anal intraepithelial neoplasia (AIN) and 82 patients (45.3%) with low-grade AIN underwent treatment. One hundred and forty-one patients (77.9%) received laser ablative treatment as an outpatient procedure. The treatment yielded cure, defined as a disease-free state at 12 months after treatment, in 63.0% (114/181). Median time to cure for the cohort was 31.5 months (95% confidence interval: 23.0-40.0). Treatment outcome showed no evidence of being affected by age, sexual preference, history of smoking or presence of high-grade disease. Median time to cure was significantly affected by a positive HIV status (P = 0.02) and the extent (volume) of the disease (P = 0.01). Contrary to the current view that treatment of HPV-related anal disease is difficult, unrewarding due to recurrences and may lead to substantial morbidity, we demonstrate that effective treatment is possible for both low- and high-grade AIN. These findings should help with the general desire to introduce screening for AIN for at-risk groups.

  17. Panama: Owning the Canal

    DTIC Science & Technology

    2014-03-01

    construction materials , waiving tariffs on Panamanian goods entering the zone, allowing Panamanians into zone hospitals and constructing a highway for more...landslide in the Gaillard Cut (also called Culebra Cut), dumping about one half million cubic yards of earth material and debris into the Panama Canal...temporary cautionary transit procedures in order to keep the channel safely operating while cleanup was ongoing. The PCC implemented landslide control

  18. 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

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

    PubMed Central

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

    2016-01-01

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

  20. New techniques for treating an anal fistula.

    PubMed

    Song, Kee Ho

    2012-02-01

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

  1. Anal erogeneity: the goose and the rat.

    PubMed

    Shengold, L

    1982-01-01

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

  2. Anal melanosis diagnosed by reflectance confocal microscopy.

    PubMed

    Cinotti, Elisa; Chol, Christelle; Perrot, Jean Luc; Labeille, Bruno; Forest, Fabien; Cambazard, Frédéric

    2014-11-01

    Until now, in vivo reflectance-mode confocal microscopy (IVCM) has been applied only to pigmented lesions of the vulvar and oral mucosa, but not to anal mucosa lesions. We present the first case in which IVCM has been used to diagnose anal melanosis. Clinical and dermoscopic features were of concern while IVCM found the draped pattern already described for genital melanosis. IVCM adds information to the clinical and dermatoscopic examination and allows skin biopsies to be avoided. Further studies are needed to define the IVCM features of anal melanosis and to compare the performance of IVCM with the findings of histological examinations.

  3. Distributed control at Love canal

    SciTech Connect

    McPherson, G.; Rider, G.J.; Sadowski, B.; Moore, M.

    1994-09-01

    Love Canal is known worldwide as the site of one of the worst non-nuclear environmental disasters in modern history. For 12 years, a Niagara Falls, New York chemical company used the canal bed as a chemical dump. This article discusses the computerized control of equipment used to remove the toxic materials from the ground under Love Canal, and how the minimization of maintenance is reducing maintenance costs and increasing operator safety.

  4. [Laparoscopic abdominoperineal resection after preoperative chemoradiotherapy for advanced carcinoma associated with anal fistula].

    PubMed

    Morikawa, Takashi; Yamashita, Kimihiro; Sumi, Yasuo; Kanemitsu, Kiyonori; Yamamoto, Masashi; Kanaji, Shingo; Imanishi, Tatsuya; Nakamura, Tetsu; Suzuki, Satoshi; Tanaka, Kenichi; Kakeji, Yoshihiro

    2014-11-01

    The patient was a 71-year-old man who was diagnosed with anal fistula 50 years previously. He complained of mucous and bloody stools. He was diagnosed with a carcinoma associated with anal fistula after biopsy. Image examination showed that the tumor was filled with mucinous substances and that it had invaded the levator ani muscle, with left external iliac and left inguinal lymph node metastases. Therefore, preoperative chemoradiotherapy for locally advanced cancer was administered. After chemoradiotherapy, the tumor and metastatic lymph nodes reduced in size. We performed laparoscopic abdominoperineal resection. Histopathologically, the tumor was revealed as a mucinous adenocarcinoma, but no cancer cells were present on the surgical margin. This case suggested that preoperative chemoradiotherapy could be effective for locally advanced carcinoma associated with anal fistula.

  5. Anal cytology and p16 immunostaining for screening anal intraepithelial neoplasia in HIV-positive and HIV-negative men who have sex with men: a cross-sectional study.

    PubMed

    Arora, Rahul; Pandhi, Deepika; Mishra, Kiran; Bhattacharya, Sambit N; Yhome, Vizodilhou A

    2014-09-01

    Summary Akin to cervical cancer in sexually-active women, men who have sex with men (MSM) are predisposed to anal cancers, especially those with HIV co-infection. This cross-sectional study endeavored to assess the prevalence of anal dysplasia using Pap smears and p16 immunostaining amongst Indian MSM. A total of 31 consecutive HIV-positive and 34 HIV-negative MSM, from a cohort of sexually transmitted infection clinic attendees, underwent anal cytological evaluation with Pap smear and p16 staining. Chi square test and coefficient of correlation were used for comparison. Eighteen (27.7%) had abnormal anal cytology; increased in HIV-positive as compared to HIV-negative men (35% versus 20%, p = 0.180). Similarly, both low-grade (25.8% versus 17.6%) and high-grade lesions (8.3% versus 4.8%) were comparable in HIV-positive and HIV-negative group. Thirteen (20%) smears were p16-positive with a sensitivity and specificity for anal dysplasia of 72.3% and 100%, respectively. Anal cytology may be used to screen for anal dysplasia in MSM irrespective of HIV status. Furthermore, the addition of p16, with greater specificity for high-grade lesions, may improve diagnostic accuracy especially for high-grade lesions. A larger study to further corroborate these observations is warranted.

  6. ASTER Suez Canal

    NASA Technical Reports Server (NTRS)

    2000-01-01

    One of the most important waterways in the world, the Suez Canal runs north to south across the Isthmus of Suez in northeastern Egypt. This image of the canal covers an area 36 kilometers (22 miles) wide and 60 kilometers (47 miles) long in three bands of the reflected visible and infrared wavelength region. It shows the northern part of the canal, with the Mediterranean Sea just visible in the upper right corner. The Suez Canal connects the Mediterranean Sea with the Gulf of Suez, an arm of the Red Sea. The artificial canal provides an important shortcut for ships operating between both European and American ports and ports located in southern Asia, eastern Africa, and Oceania. With a length of about 195 kilometers (121 miles) and a minimum channel width of 60 meters (197 feet), the Suez Canal is able to accommodate ships as large as 150,000 tons fully loaded. Because no locks interrupt traffic on this sea level waterway, the transit time only averages about 15 hours. ASTER acquired this scene on May 19, 2000.

    Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) is one of five Earth-observing instruments launched December 18, 1999, on NASA's Terra satellite. The instrument was built by Japan's Ministry of International Trade and Industry. A joint U.S./Japan science team is responsible for validation and calibration of the instrument and the data products. Dr. Anne Kahle at NASA's Jet Propulsion Laboratory, Pasadena, California, is the U.S. science team leader; Moshe Pniel of JPL is the project manager. ASTER is the only high-resolution imaging sensor on Terra. The primary goal of the ASTER mission is to obtain high-resolution image data in 14 channels over the entire land surface, as well as black and white stereo images. With revisit time of between 4 and 16 days, ASTER will provide the capability for repeat coverage of changing areas on Earth's surface. Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) is one of five

  7. 15. ROUTE OF CANAL NORTHWEST OF THE DILLON CEMETERY. CANAL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. ROUTE OF CANAL NORTHWEST OF THE DILLON CEMETERY. CANAL PASSES BELOW HILLSIDE IN FOREGROUND, THROUGH THE LOWER EDGE OF THE TREES ON LEFT, ON FAR SIDE OF SMALL VALLEY JUST RIGHT OF CENTER, AND AROUND THE PROMINENT POINT ON THE RIGHT. VIEW IS TO THE EAST-SOUTHEAST. - Snake River Ditch, Headgate on north bank of Snake River, Dillon, Summit County, CO

  8. Osmolarity and root canal antiseptics.

    PubMed

    Rossi-Fedele, G; Guastalli, A R

    2014-04-01

    Antiseptics used in endodontics for disinfection purposes include root canal dressings and irrigants. Osmotic shock is known to cause the alteration of microbial cell viability and might have a role in the mechanism of action of root canal antiseptics. The aim of this review was to determine the role of osmolarity on the performance of antiseptics in root canal treatment. A literature search using the Medline electronic database was conducted up to 30 May 2013 using the following search terms and combinations: 'osmolarity AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmolality AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmotic AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmosis AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; sodium chloride AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm'. Publications were included if the effects of osmolarity on the clinical performance of antiseptics in root canal treatment were stated, if preparations with different osmolarities values were compared and if they were published in English. A hand search of articles published online, 'in press' and 'early view', and in the reference list of the included papers was carried out following the same criteria. A total of 3274 publications were identified using the database, and three were included in the review. The evidence available in endodontics suggests a possible role for hyperosmotic root canal medicaments as disinfectants, and that there is no influence of osmolarity on the tissue dissolution capacity of sodium hypochlorite. There are insufficient data to obtain a sound conclusion regarding the role of hypo-osmosis in root canal disinfection, or osmosis in any further desirable

  9. 173. CANAL TENDER OPERATING LOCK MACHINERY ON THE MORRIS CANAL. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    173. CANAL TENDER OPERATING LOCK MACHINERY ON THE MORRIS CANAL. AS THE LOCK TENDER TURNS THE CRANK, A SMALL COGGED WHEEL (PINION) ON THE CRANK TURNS A LARGER COGGED WHEEL, (MAIN GEAR). MAIN GEAR ENGAGES A COGGED BAR CALLED A TRAVELLER WHICH MOVES FORWARD OR BACK DEPENDING ON WHICH WAY THE CRANK IS TURNED. CONNECTED TO THE TRAVELLER ARE TO LONG RODS (GATE ARMS) WHICH IN TURN ARE CONNECTED TO THE GATE'S TOP BEAM (ONE FOR EACH GATE). AS THE TRAVELLER MOVES FORWARD THE GATE ARMS EXTEND PUSHING THE GATES OPEN. - Morris Canal, Phillipsburg, Warren County, NJ

  10. Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair.

    PubMed

    Harvey, Marie-Andrée; Pierce, Marianne; Alter, Jens-Erik W; Chou, Queena; Diamond, Phaedra; Epp, Annette; Geoffrion, Roxana; Harvey, Marie-Andrée; Larochelle, Annick; Maslow, Kenny; Neustaedter, Grace; Pascali, Dante; Pierce, Marianne; Schulz, Jane; Wilkie, David; Sultan, Abdul; Thakar, Ranee

    2015-12-01

    Objectif : Analyser les données probantes traitant des lésions obstétricales du sphincter anal (LOSA) en ce qui concerne leur diagnostic, les techniques visant leur réparation et les résultats de l’intervention. Formuler des recommandations permettant d’éclairer les conseils offerts aux patientes ayant connu des LOSA en ce qui a trait à la voie d’accouchement à privilégier dans le cadre des grossesses subséquentes. Options : Les fournisseurs de soins obstétricaux qui comptent des patientes ayant connu des LOSA disposent de l’option de réparer le sphincter anal en faisant appel à la méthode de suture « bout à bout » (end-to-end) ou à la méthode « en paletot » (overlapping). Ils pourraient également être appelés à conseiller des femmes ayant déjà connu des LOSA en ce qui a trait à la voie d’accouchement à privilégier pour les grossesses subséquentes. Issues : Le critère d’évaluation était la continence anale à la suite d’une réparation primaire de LOSA et à la suite d’un accouchement subséquent. Résultats : La littérature publiée a été récupérée par l’intermédiaire de recherches menées dans Medline, EMBASE et The Cochrane Library en mai 2011 au moyen d’un vocabulaire contrôlé (p. ex. anal canal, obstetrics, obstetric labour complication, pregnancy complication, treatment outcome, surgery, quality of life) et de mots clés (p. ex. obstetrical anal sphincter injur*, anus sphincter, anus injury, delivery, obstetrical care, surgery, suturing method, overlap, end-to-end, feces incontinence) appropriés. Les résultats ont été restreints aux analyses systématiques, aux études observationnelles et aux essais comparatifs randomisés / essais cliniques comparatifs. Aucune restriction n’a été imposée en matière de date ou de langue. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu’en septembre 2014. La littérature grise (non

  11. Method for Constructing Standardized Simulated Root Canals.

    ERIC Educational Resources Information Center

    Schulz-Bongert, Udo; Weine, Franklin S.

    1990-01-01

    The construction of visual and manipulative aids, clear resin blocks with root-canal-like spaces, for simulation of root canals is explained. Time, materials, and techniques are discussed. The method allows for comparison of canals, creation of any configuration of canals, and easy presentation during instruction. (MSE)

  12. The Love Canal: Beyond science?

    NASA Astrophysics Data System (ADS)

    Bell, Peter M.

    When in 1978, the New York State Department of Health issued the report, ‘Love Canal—Public Health Time Bomb,’ the serious effects of chemical waste contamination in the Love Canal area became an issue of national concern. A few ‘studies’ since then have produced results in concert with those of initial reports that described ‘conditions of acute health effects’ as being linked to hazardous wastes incorporated in landfill in the Love Canal site near Niagara Falls, New York. Now that a ‘blue ribbon’ panel of experts from the medical sciences has reviewed the problems of Love Canal, however, a different view has emerged. The ‘Report of the Governors' Panel to Review Scientific Studies and the Development of Public Policy on Problems Resulting from Hazardous Wastes,’ transmitted in October of this year, identifies the following factors about the health effects at Love Canal:

  13. Superior Semicircular Canal Dehiscence (SSCD)

    MedlinePlus

    ... canal that is being activated. Analysis of the eye movements evoked by sound and pressure stimuli in patients ... to the identification of this syndrome. These evoked eye movements often align with the plane of the superior ...

  14. Looking back at Love Canal

    SciTech Connect

    Deegan, J. Jr.

    1987-05-01

    In the first part of this series (ES and T, April 1987, pp. 328-31) it was pointed out that the methods and conclusions of EPA's Love Canal Study were the subject of some controversy in the environmental community. Others defended the agency's approaches and methods. Part 2 makes no attempt to resolve the controversy; its purpose is to present the results and conclusions of the Love Canal.

  15. Analysis of anal secretions from phlaeothripine thrips.

    PubMed

    Suzuki, Takahisa; Haga, Kazuo; Tsutsumi, Tadaaki; Matsuyama, Shigeru

    2004-02-01

    The anal secretions of 16 phlaeothripine thrips species (Thysanoptera: Phlaeothripidae) were studied, including a reinvestigation of three species previously reported. A total of 37 components were detected, including hydrocarbons, acetates, terpenes, carboxylic acids, a quinone, an aromatic compound, and a pyranone compound. The secretions of all species were composed of some of these components, with Xylaplothrips inquilinus possessing as many as 11 components. Of these components, (Z)-9-octadecene, (Z)-9-nonadecene, nonadecadiene, octanoic acid, decanoic acid, geranial, neral, alpha-pinene, beta-pinene, caryophyllene, 2-hydroxy-6-methylbenzaldehyde, and two unidentified monoterpenes [UK-I (M+136) and UK-II (M+168)] were detected for the first time. The chemicals were species-specific; four Liothrips species and three Holothrips species could be distinguished from each other and their congeners by the GC profiles of the ether extracts of their anal secretions. The anal secretions of gall-inducing thrips commonly contained terpenes. of which citral (a mixture of geranial and neral) and beta-acaridial repelled ants or had antifungal activity. The findings suggest that these terpenes play a defensive role and prevent galls from fungal infestation. 3-Butanoyl-4-hydroxy-6-methyl-2H-pyran-2-one, found from three Holothrips spp., caused paralysis in ants. Chemical analysis of anal secretion components is a useful method for the classification of tubuliferan species that are difficult to distinguish on the basis of morphological characters.

  16. 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…

  17. Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure.

    PubMed

    Tauro, Leo Francis; Shindhe, Vittal V; Aithala, P Sathyamoorthy; Martis, John J S; Shenoy, H Divakar

    2011-08-01

    Chronic Anal Fissure (CAF) is common perineal condition and well-known painful entity. Standard surgical treatment even though available, may require long hospital stay and sometimes have worrying complications like anal incontinence. So non-surgical treatment, Glyceryl Trinitrate has been shown to be an effective for chronic anal fissure. It decreases anal tone and ultimately heals the anal fissure. The present study is the attempt to know the efficacy of 0.2% Glyceryl Trinitrate ointment in the treatment of chronic anal fissure and to compare the effectiveness of 0.2% Glyceryl Trinitrate ointment (GTN) versus fissurectomy with lateral internal sphincterotomy (LIS) and fissurectomy with posterior internal sphincterotomy (PIS) in the management of chronic anal fissure. This is a prospective comparative study of management of chronic anal fissure done in our hospital during the period of one and half year from October 2005 to March 2007. Thirty patients treated with 0.2% Glyceryl Trinitrate ointment and 30 patients treated with fissurectomy and lateral internal sphincterotomy and 30 patients treated with posterior internal sphincterotomy, for chronic anal fissure were selected for study. A single brand of 0.2% Glyceryl Trinitrate ointment (Nitrogesic) used for trial arm. Dose of administration was 1.5 cm to 2 cm in the anal canal with device provided by manufacturers of the proprietary preparation and applied twice a daily for 12 weeks. Patients were followed up for 12 weeks and thereafter evaluated for relief of symptoms in all three groups. Observations were recorded at 2 weeks; 6 weeks and 12 weeks of follow up period, regarding symptoms like pain and bleeding during defecation, healing of CAF and also for side effects like headache in GTN group and flatus, fecal incontinence in surgical groups. Data collected in proforma and analyzed. Study revealed CAF was more in male 59 patients (66%) than the female 31 patients (34%), the ratio being 1: 0.52. The

  18. Management of rare, low anal anterior fistula exception to Goodsall's rule with Kṣārasūtra

    PubMed Central

    Shindhe, Pradeep S.

    2014-01-01

    Anal fistula (bhagandara) is a chronic inflammatory condition, a tubular structure opening in the ano-rectal canal at one end and surface of perineum/peri-anal skin on the other end. Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening. This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn's disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure. The condition poses difficulty for a surgeon in treating due to issues like patient hesitation, trouble in preparing kṣārasūtra, natural and routine infection with urine, stool etc., and dearth of surgical experts and technique. We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra. PMID:25538355

  19. 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.

  20. 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,…

  1. Can Vaginal Cancer Be Prevented?

    MedlinePlus

    ... well as anal and genital warts. Cervarix ® , another HPV vaccine available in the US, also helps prevent some ... help prevent vaginal cancer or pre-cancer More HPV vaccines are being developed and tested. For more information ...

  2. HIV Infection and Cancer Risk

    MedlinePlus

    ... some subtypes of non-Hodgkin and Hodgkin lymphoma . Human papillomavirus (HPV) causes cervical cancer and some types of anal , penile , vaginal , vulvar , and head and neck cancer . Hepatitis B virus (HBV) and ...

  3. Anal cytological abnormalities and epidemiological correlates among men who have sex with men at risk for HIV-1 infection

    PubMed Central

    2012-01-01

    Background The incidence of anal cancer, a Human Papillomavirus (HPV)-related neoplasia, has been increasing in recent decades, mainly in men who have sex with men (MSM). Cytological changes of the anal epithelium induced by HPV can be detected through an anal pap smear. This study aimed to evaluate the prevalence and epidemiological correlates of anal cytological abnormalities among relatively young MSM at risk for HIV-1 infection, to help clarify whether or not this population deserves further investigation to assess the presence of anal cancer precursor lesions. Methods MSM were recruited among attendees of a large STI clinic for a HIV-1 screening program. Anal samples, collected with a Dracon swab in PreservCyt, were used both for liquid-based cytology and HPV testing by the Linear Array HPV Genotyping Test. Data regarding socio-demographic characteristics and sexual behavior were collected in face-to-face interviews. Results A total of 346 MSM were recruited (median age 32 years). Overall, 72.5% of the individuals had an anal HPV infection, with 56.1% of them being infected by oncogenic HPV genotypes. Anal cytological abnormalities were found in 29.8% of the cases (16.7% ASC-US and 13.1% L-SIL). Presence of ASC-US+ was strongly associated with infection by any HPV type (OR=4.21, 95% CI: 1.97-9.23), and particularly by HPV 16 and/or 18 (OR=5.62, 95% CI: 2.33-13.81). A higher proportion of ASC-US+ was found in older MSM, in those with a higher number of lifetime partners and in those with a history of ano-genital warts. However, none of these variables or the others analyzed showed any significant association with abnormal cytological findings. Conclusions The presence of anal cytological abnormalities in about one third of the recruited MSM and their strong association with HPV infection, in particular that caused by HPV 16 and/or 18, might provide a further complement to the data that now support the introduction of HPV vaccination among MSM to protect them

  4. Corinth Canal, Greece

    NASA Technical Reports Server (NTRS)

    2006-01-01

    The Isthmus of Corinth has played a very important role in the history of Greece. It is the only land bridge between the country's north (Attica) and south (Peloponnese). It is a 6 km wide tongue of land separating the Gulf of Corinth from the Saronic Sea. Populations, armies and commodities have got to move through it. In the 6th century BCE, the Greeks built the Diolkos, a 10 meter-wide stone roadway to pull ships across the Isthmus on wooden cylinders and wheeled vehicles. In 1882, a canal was started and completed 11 years later. It is 6343 meters long, 25 meters wide, and 8 meters deep.

    With its 14 spectral bands from the visible to the thermal infrared wavelength region, and its high spatial resolution of 15 to 90 meters (about 50 to 300 feet), ASTER images Earth to map and monitor the changing surface of our planet.

    ASTER is one of five Earth-observing instruments launched December 18, 1999, on NASA's Terra satellite. The instrument was built by Japan's Ministry of Economy, Trade and Industry. A joint U.S./Japan science team is responsible for validation and calibration of the instrument and the data products.

    The broad spectral coverage and high spectral resolution of ASTER provides scientists in numerous disciplines with critical information for surface mapping, and monitoring of dynamic conditions and temporal change. Example applications are: monitoring glacial advances and retreats; monitoring potentially active volcanoes; identifying crop stress; determining cloud morphology and physical properties; wetlands evaluation; thermal pollution monitoring; coral reef degradation; surface temperature mapping of soils and geology; and measuring surface heat balance.

    The U.S. science team is located at NASA's Jet Propulsion Laboratory, Pasadena, Calif. The Terra mission is part of NASA's Science Mission Directorate.

    Size: 25.3 by 37.7 kilometers (15.7 by 23.4 miles) Location: 37.9 degrees North latitude, 23 degrees East longitude

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

    PubMed

    Zhou, Zhiyang

    2015-12-01

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

  6. Ship canals and aquatic ecosystems

    USGS Publications Warehouse

    Aron, William I.; Smith, Stanford H.

    1971-01-01

    Through a combination of ecosystem homeostasis and the perversity of man and nature, oftentimes the significant biological changes effected by environmental modifications are not detected until long after the initial change has taken place. The immediate impact, which may range from the spectacular to the undetectable, is a deceptive measure of the long-term and often more important changes in the ecosystem. Two major engineering achievements illustrate this premise: (i) construction of the Erie Canal, which provided access from the Atlantic Ocean to the Great Lakes, and the Welland Canal, which bypasses the block between Lakes Ontario and Erie created by Niagara Falls (Fig. 1), and (ii) construction of the Suez Canal between the Red Sea and the Mediterranean Sea.

  7. Malignant familial adenomatous polyposis treated by laparoscopic colectomy and ileal pouch anal anastomosis: a case report.

    PubMed

    Zaharie, Florin; Ciorogar, George; Zaharie, Roxana; Tantau, Marcel; Iancu, Cornel; Mocan, Lucian

    2014-12-01

    The mean age of colorectal cancer in untreated familial adenomatous polyposis (FAP) is 39 years. We present the case of a 21-year-old patient with FAP and colorectal cancer. The patient was detected with significant family history: her mother died at age 45 with colon cancer; two uncles were diagnosed with colon cancer at the age of 40 and 43 and one aunt at the age of 45 with colon cancer and gastric cancer. The treatment was laparoscopic restorative proctocolectomy with total excision of the mesorectum and ileal pouch anal anastomosis completed with endoanal excision of inferior rectal polyps. The histopathological report described a well differentiated rectal adenocarcinoma T1N1aMx developed on a tubulo-villous adenoma located on the rectosigmoid jonction, the rest of the polyps with benign histology.

  8. Human Papillomavirus at Multiple Sites Associated with Anal Squamous Intraepithelial Lesions in HIV-Seropositive Individuals

    PubMed Central

    Chuang, Eleanore; Lim, Eunjung; Milne, Cris; Zhu, Xuemei; Agsalda, Melissa; Killeen, Jeffrey; Miller, F DeWolfe; Hernandez, Brenda Y.; Shiramizu, Bruce

    2016-01-01

    Objective HIV-Seropositive patients have higher risk of HPV infection even on anti-retroviral therapy. Infection with high-risk HPV genotypes can cause dysplasia leading to cancer. This study assessed HPV at different anatomical sites in HIV-seropositive individuals and factors associated with anal squamous intraepithelial lesions (ASIL). Methods Specimens were obtained from multiple anatomical sites for each participant in conjunction with routine screening for anal dysplasia. Female specimens included cervical and anal cytologies and oral wash. Male specimens included anal cytologies, oral wash, and exfoliated cells from penile head, penile shaft, scrotum, and from uncircumcised subjects, inner foreskin. Demographic and clinical characteristics were recorded. Following DNA extraction, HIV DNA copy was assessed by qPCR; HPV was genotyped. Statistical analyses included calculation of odds ratios (OR) and 95% confidence intervals (CI), t-tests or Mann-Whitney tests. Results Males were more likely to have ASIL: 29/50 (58%) compared to 1/11 females (9%) (OR=13.81, 95% CI: 1.64–116.32). HPV 6 or 11 in anal specimens was significantly associated with ASIL (OR= 6.29, 95% CI: 1.49–26.44). Number of HPV genotypes in anal specimens was also significant: ASIL+ (3.4 ± 3.1) versus ASIL− (1.6 ± 3.1) (p=0.009). Among 44 males, HPV was detected from at least one anatomical site for 33 participants (75%): 27 anus (61%), 19 oral wash (44%), 17 penile shaft (39%), 11 scrotum (26%), 10 penile head (23%), 0 foreskin. Detection of HPV in penile shaft specimens was significantly associated with ASIL (OR=6.79, 95% CI: 1.57–29.36) as was number of HPV genotypes in penile shaft specimens: ASIL+ (2.4 ± 4.0) versus ASIL− (0.6 ± 1.7) (p=0.025). Only 1/11 females had ASIL; only 1/11 females had cervical dysplasia: OR was not estimable due to small numbers. Conclusions Males were more prone to ASIL than females. HPV at anal as well as non-anal sites may be indicative of ASIL. PMID

  9. Sonic instruments in root canal therapy.

    PubMed

    Waplington, M; Lumley, P J; Walmsley, A D

    1995-10-01

    Although hand instrumentation is considered the most acceptable method of preparing root canals, sonic instruments may be useful additions to the endodontic armamentarium. Sonic instrumentation may be incorporated as an adjunct to traditional techniques for shaping the root canal. The use of such instruments may assist the practitioner during root canal treatment in general practice.

  10. [Anatomical variations in the hypoglossal canal].

    PubMed

    De Francisco, M; Lemos, J L; Liberti, E A; Adamo, J; Jácomo, A L; Matson, E

    1990-01-01

    In this paper, 492 human dried skulls grouped according to sex and race (White and no White) were examined and the presence of a double hypoglossal canal was observed in 97 skulls. The statistical analysis allowed us to conclude that no significative difference exists in race X canal type; sex X canal type; race X side and sex X side interations.

  11. Erie Canal Technology: Stump Pullers

    NASA Astrophysics Data System (ADS)

    Greenslade, Thomas B.

    2013-10-01

    Many years ago I saw a picture of a huge set of wheels that was used to remove tree stumps during the construction of the Erie Canal (1817-1825) and was intrigued by its use of leverage, mechanical advantage, and torque. Figure 1 is a scale model of the device based on my memory of the (lost) picture and published accounts.

  12. Erie Canal Technology: Stump Pullers

    ERIC Educational Resources Information Center

    Greenslade, Thomas B., Jr.

    2013-01-01

    Many years ago I saw a picture of a huge set of wheels that was used to remove tree stumps during the construction of the Erie Canal (1817-1825) and was intrigued by its use of leverage, mechanical advantage, and torque. Figure 1 is a scale model of the device based on my memory of the (lost) picture and published accounts.

  13. [Endodontic microbiology: antimicrobial canal medications].

    PubMed

    Seltzer, S; Farber, P A

    1989-06-01

    Medicaments used for reducing or eliminating microorganisms from infected root canals include: irrigating solutions, such as sodium hypochlorite, urea peroxide and hydrogen peroxide, chloramine, iodine-potassium-iodide solution, and chlorhexidine solution. In addition, various intracanal drugs, such as calcium hydroxide and antibiotics, are in use. The characteristics of these drugs are discussed.

  14. Anal fistula with foot extension—Treated by kshara sutra (medicated seton) therapy: A rare case report

    PubMed Central

    Ramesh, P. Bhat

    2013-01-01

    INTRODUCTION An ‘anal’ fistula is a track which communicates anal canal or rectum and usually is in continuity with one or more external openings. Distant communication from rectum is rare. It is a challenging disease because of its recurrence especially, with high level and distant communications. Ksharasutra (medicated seton) therapy is being practiced in India with high success rate (recurrence of 3.33%) in the management of complicated anal fistula. PRESENTATION OF CASE A 56 year old man presented with recurrent boils in the left lower limb at different places from thigh to foot. He underwent repeated incision and drainage at different hospitals. Examination revealed sinus with discharge and multiple scars on left lower limb from thigh up to foot. Suspecting anal fistula, MRI was advised which revealed a long cutaneous fistula from rectum to left lower limb. Patient was treated with Ksharasutra therapy. Within 6 months of treatment whole tract was healed completely. DISCUSSION Sushrutha (500BC) was the first to explain the role of surgical excision and use of kshara sutra for the management of anal fistula. Ksharasutra therapy showed least recurrence. Fistula from rectum to foot is of extremely rare variety. Surgical treatment of anal fistula requires hospitalization, regular post-operative care, is associated with a significant risk of recurrence (0.7–26.5%) and a high risk of impaired continence (5–40%). CONCLUSION Rectal fistula communicating till foot may be a very rare presentation in proctology practice. Kshara sutra treatment was useful in treating this condition, with minimal surgical intervention with no recurrence. PMID:23702360

  15. Minimally Invasive Anal Fistula Treatment (MAFT)-An Appraisal of Early Results in 416 Patients.

    PubMed

    Chowbey, P K; Khullar, R; Sharma, A; Soni, V; Najma, K; Baijal, M

    2015-12-01

    Minimally invasive anal fistula treatment (MAFT) was introduced to minimize early postoperative morbidity, preserve sphincter continence, and reduce recurrence. We report our early experience with MAFT in 416 patients. Preoperative MRI was performed in 150 patients initially and subsequently thereafter. The technique involves fistuloscope-aided localization of internal fistula opening, examination and fulguration of all fistula tracks, and secure stapled closure of internal fistula opening within anal canal/rectum. MAFT was performed as day-care procedure in 391 patients (93.9 %). During surgery, internal fistula opening could not be located in 100 patients (24 %). Seven patients required readmission to hospital. Mean visual analog scale scores for pain on discharge and at 1 week were 3.1 (1-6) and 1.6 (0-3), respectively. Mean duration for return to normal activity was 3.2 days (2-11 days). Fistula recurrence was observed in 35/134 patients (26.1 %) at 1 year follow-up. MAFT may be performed as day-care procedure with benefits of less pain, absence of perianal wounds, faster recovery, and preservation of sphincter continence. However, long-term results from more centers are needed especially for recurrence.

  16. [The anal fistula disease and abscess].

    PubMed

    Strittmatter, Bernhard

    2004-01-01

    There are two forms of anal fistulas arising from its pathogenesis: the acute stage is the abscess, whereas the chronic stage is the fistula in ano. The classification of the fistula in ano is named after Parks. Pathogenesis and classification are explained. For complete cure, every abscess needs precise examination to be able to show the course and shape of the fistula. The surgical procedure depends on the fistula tract. Most fistulas can be operated by means of a fistulotomy or fistulectomy. Recovery depends on locating the total fistula tract.

  17. Squamous cell carcinoma of the anal sacs in three dogs.

    PubMed

    Mellett, S; Verganti, S; Murphy, S; Bowlt, K

    2015-03-01

    Anal sac squamous cell carcinoma is rare in dogs. Five cases have been previously reported, treatment of which involved surgery alone. This report describes three further cases of canine anal sac squamous cell carcinoma which underwent medical (meloxicam) management alone, resulting in survival of up to seven months. No metastases were identified. Squamous cell carcinoma, although extremely uncommon, should be considered as a possible differential diagnosis when a dog is presented for investigation of an anal sac mass.

  18. Molecular biology of anal squamous cell carcinoma: implications for future research and clinical intervention.

    PubMed

    Bernardi, Maria-Pia; Ngan, Samuel Y; Michael, Michael; Lynch, A Craig; Heriot, Alexander G; Ramsay, Robert G; Phillips, Wayne A

    2015-12-01

    Anal squamous cell carcinoma is a human papillomavirus-related disease, in which no substantial advances in treatment have been made in over 40 years, especially for those patients who develop disease relapse and for whom no surgical options exist. HPV can evade the immune system and its role in disease progression can be exploited in novel immunotherapy platforms. Although several studies have investigated the expression and inactivation (through loss of heterozygosity) of tumour suppressor genes in the pathways to cancer, no clinically valuable biomarkers have emerged. Regulators of apoptosis, including survivin, and agents targeting the PI3K/AKT pathway, offer opportunities for targeted therapy, although robust data are scarce. Additionally, antibody therapy targeting EGFR may prove effective, although its safety profile in combination with standard chemoradiotherapy has proven to be suboptimal. Finally, progress in the treatment of anal cancer has remained stagnant due to a lack of preclinical models, including cell lines and mouse models. In this Review, we discuss the molecular biology of anal squamous cell carcinoma, clinical trials in progress, and implications for novel therapeutic targets. Future work should focus on preclinical models to provide a resource for investigation of new molecular pathways and for testing novel targets.

  19. ACR Appropriateness Criteria on Resectable Rectal Cancer

    SciTech Connect

    Suh, W. Warren; Konski, Andre A.; Mohiuddin, Mohammed; Poggi, Matthew M.; Regine, William F.; Cosman, Bard C.; Saltz, Leonard; Johnstone, Peter A.S.

    2008-04-01

    The American College of Radiology (ACR) Appropriateness Criteria on Resectable Rectal Cancer was updated by the Expert Panel on Radiation Oncology-Rectal/Anal Cancer, based on a literature review completed in 2007.

  20. Anal human papillomavirus infection in a street-based sample of drug using HIV-positive men.

    PubMed

    Cranston, R D; Murphy, R; Weiss, R E; Da Costa, M; Palefsky, J; Shoptaw, S; Gorbach, P M

    2012-03-01

    HIV facilitates an increase in human papillomavirus (HPV)-associated conditions. HIV-positive men living in a substance use context in Los Angeles, USA, were recruited using respondent-driven sampling, completed a questionnaire and had biological samples including an anal HPV swab taken. A total of 316 evaluable men were enrolled in the study. The prevalence of any HPV, high-risk (HR) infection and multiple-type infection was highest for men who have sex with men (MSM) (93.9%, 64.6% and 29.7%, respectively). When any HPV and HR-HPV prevalence in all men was stratified by age, the youngest group had 100% and 68.2% prevalence, respectively, with similarly high rates maintained up to age 49 years. The individual's use of alcohol, marijuana, cocaine, methamphetamine or heroin was not significantly associated with anal HPV detection. In this marginalized population, high prevalence rates of anal HPV and HR-HPV occurring over a wide age range may increase the individual's risk for anal dysplasia and anal cancer.

  1. Management of Six Root Canals in Mandibular First Molar

    PubMed Central

    Gomes, Fabio de Almeida; Sousa, Bruno Carvalho

    2015-01-01

    Success in root canal treatment is achieved after thorough cleaning, shaping, and obturation of the root canal system. This clinical case describes conventional root canal treatment of an unusual mandibular first molar with six root canals. The prognosis for endodontic treatment in teeth with abnormal morphology is unfavorable if the clinician fails to recognize extra root canals. PMID:25685156

  2. The primate semicircular canal system and locomotion

    PubMed Central

    Spoor, Fred; Garland, Theodore; Krovitz, Gail; Ryan, Timothy M.; Silcox, Mary T.; Walker, Alan

    2007-01-01

    The semicircular canal system of vertebrates helps coordinate body movements, including stabilization of gaze during locomotion. Quantitative phylogenetically informed analysis of the radius of curvature of the three semicircular canals in 91 extant and recently extinct primate species and 119 other mammalian taxa provide support for the hypothesis that canal size varies in relation to the jerkiness of head motion during locomotion. Primate and other mammalian species studied here that are agile and have fast, jerky locomotion have significantly larger canals relative to body mass than those that move more cautiously. PMID:17576932

  3. Love Canal: environmental and toxicological studies

    SciTech Connect

    Kim, C.S.

    1981-01-01

    The New York State Department of Health has been involved at the Love Canal since 1978. The State has carried out numerous environmental and toxicological studies. The major purposes for these studies were to define how Love Canal contaminants might be escaping into the environment at large, what paths contaminant migration might take, and what toxicological effects Love Canal chemicals might have individually and together. Although underground contaminant migration was hypothesized along swales and underground utility bedding, these mechanisms have been proven not to be operative except for some migration along the utility bedding under Frontier Avenue. In general no underground migration has occurred outside the confines of the three city blocks that contain the Love Canal referred to as the ''first ring''. Studies have been confused by apparent burial of waste materials in areas proximate but not directly connected to the Love Canal. Migration of Love Canal leachate has occurred through storm sewers. Love Canal contaminants have reached creeks to the north and the Niagara River to the south through storm sewer transport. In spite of finding 2, 3, 7, 8 tetrachlorodibenzoparadioxin (TCDD), toxicological studies in situ and through exposure to volatile components in Love Canal soils do not indicate unusual toxicity. Animal studies continue in an attempt to determine the teratogenic and fetotoxic potential of Love Canal chemicals under different routes of exposure.

  4. Prevalence of anal high-risk human papillomavirus infections among HIV-positive and HIV-negative men who have sex with men (MSM) in Nigeria

    PubMed Central

    Nowak, Rebecca G.; Gravitt, Patti E.; He, Xin; Ketende, Sosthenes; Anom, Wuese; Omuh, Helen; Blattner, William A.; Charurat, Manhattan E.

    2016-01-01

    Background Prevalence estimates of anal high-risk human papillomavirus (HR-HPV) are needed in sub-Saharan Africa where HIV is endemic. This study evaluated anal HR-HPV in Nigeria among HIV-positive and HIV-negative men who have sex with men (MSM) for future immunization recommendations. Methods We conducted a cross-sectional study to compare the prevalence of anal HR-HPV infections between 64 HIV-negative and 90 HIV-positive MSM. Multivariate Poisson regression analyses were used to examine demographic and behavioral risk factors associated with any HR-HPV infections. Results The median age of the 154 participants was 25 years (interquartile range [IQR]: 22-28, range: 16-38) and the median age at initiation of anal sex with another man was 16 years (IQR: 13-18, range: 7-29). The prevalence of anal HR-HPV was higher among HIV-positive than HIV-negative MSM (91.1% vs. 40.6%, p<0.001). In the multivariate analysis, HIV infection (adjusted prevalence ratio [aPR]: 2.02, 95% CI: 1.49-2.72), ten years or more since anal sexual debut (aPR: 1.26, 95% CI: 1.07-1.49), and concurrent relationships with men (aPR: 1.32, 95% CI: 1.04-1.67) were associated with increased anal HR-HPV prevalence. Conclusions Anal HR-HPV infection is high for young Nigerian MSM and rates are amplified in those co-infected with HIV. Providing universal coverage as well as catchup immunization for young MSM may be an effective anal cancer prevention strategy in Nigeria. PMID:26967301

  5. Treatment of non-IBD anal fistula.

    PubMed

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

    2015-05-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should be supplemented with an endoluminal ultrasound scan and/or an MRI scan. St. Mark's fistula chart should be used for the description. Simple fistulas are amenable to fistulotomy, whereas treatment of complex fistulas requires special expertise and management of all available treatment modalities to tailor the right operation to the individual patient. The given levels of evidence and grades of recommendations are according to the Oxford Centre for Evidence-based Medicine (www.cemb.net).

  6. 5 CFR 315.601 - Appointment of former employees of the Canal Zone Merit System or Panama Canal Employment System.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Canal Zone Merit System or Panama Canal Employment System. 315.601 Section 315.601 Administrative... employees of the Canal Zone Merit System or Panama Canal Employment System. (a) Agency authority. This... Zone Merit System, which was in effect before March 31, 1982, or under the Panama Canal...

  7. 5 CFR 315.601 - Appointment of former employees of the Canal Zone Merit System or Panama Canal Employment System.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Canal Zone Merit System or Panama Canal Employment System. 315.601 Section 315.601 Administrative... employees of the Canal Zone Merit System or Panama Canal Employment System. (a) Agency authority. This... Zone Merit System, which was in effect before March 31, 1982, or under the Panama Canal...

  8. 5 CFR 315.601 - Appointment of former employees of the Canal Zone Merit System or Panama Canal Employment System.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Canal Zone Merit System or Panama Canal Employment System. 315.601 Section 315.601 Administrative... employees of the Canal Zone Merit System or Panama Canal Employment System. (a) Agency authority. This... Zone Merit System, which was in effect before March 31, 1982, or under the Panama Canal...

  9. 10. DETAIL, SOUTHEAST SPAN THROUGH CANAL, VIEW BLOCKED BY STEEL, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. DETAIL, SOUTHEAST SPAN THROUGH CANAL, VIEW BLOCKED BY STEEL, CLAD COUNTER WEIGHT, WATER SPAN RAISED OUT OF VIEW - Cape Cod Canal Lift Bridge, Spanning Cape Cod Canal, Buzzards Bay, Barnstable County, MA

  10. 3. August, 1971. VIEW ALONG CANAL SHOWING BORDER PATH AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. August, 1971. VIEW ALONG CANAL SHOWING BORDER PATH AND BRIDGE FOR INSPECTION - ABOUT ONE MILE FROM CANAL HEAD. - Hurricane Irrigation Canal, State Route 15 Vicinity, Hurricane, Washington County, UT

  11. 5. Division Gates of the Consolidated Canal, looking northeast. The ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. Division Gates of the Consolidated Canal, looking northeast. The Tempe Canal heads here (left). Photographer: Mark Durben, February 1989. Source: SRPA - Tempe Canal, South Side Salt River in Tempe, Mesa & Phoenix, Tempe, Maricopa County, AZ

  12. 15. VIEW OF GAGE IRRIGATION CANAL NEAR HILLTOP DRIVE AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. VIEW OF GAGE IRRIGATION CANAL NEAR HILLTOP DRIVE AND BARTON ROAD, SHOWING END OF SIPHON. CANAL FOLLOWS CONTOUR OF HILL UNDER DIRT ROAD - Gage Irrigation Canal, Running from Santa Ana River to Arlington Heights, Riverside, Riverside County, CA

  13. 11. 'Y' CONNECTOR TO PICACHO RESERVOIR ON MAIN CANAL. VIEW ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. 'Y' CONNECTOR TO PICACHO RESERVOIR ON MAIN CANAL. VIEW LOOKING WEST FROM MAIN CANAL - San Carlos Irrigation Project, Marin Canal, Amhurst-Hayden Dam to Picacho Reservoir, Coolidge, Pinal County, AZ

  14. Dundee Canal Industrial Historic District, Beginning at George Street in ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Dundee Canal Industrial Historic District, Beginning at George Street in Passaic & extending north along Dundee Canal approximately 1.2 miles to Canal headgates opposite East Clifton Avenue in Clifton, Passaic, Passaic County, NJ

  15. Root Canal Treatment of a Maxillary Second Premolar with Two Palatal Root Canals: A Case Report

    PubMed Central

    Golmohammadi, Maryam; Jafarzadeh, Hamid

    2016-01-01

    Accurate diagnosis of the root canal morphology and anatomy is essential for thorough shaping and cleaning of the entire root canal system and consequent successful treatment. This report describes a case of maxillary second premolar with two roots and three root canals (two mesial and distal palatal canals). The case report underlines the importance of complete knowledge about root canal morphology and possible variations, coupled with clinical and radiographic examination in order to increase the ability of clinicians to treat difficult cases. PMID:27471538

  16. Seroconversion Following Anal and Genital HPV Infection in Men: The HIM Study

    PubMed Central

    Giuliano, Anna R.; Viscidi, Raphael; Torres, B. Nelson; Ingles, Donna J.; Sudenga, Staci L.; Villa, Luisa L.; Baggio, Maria Luiza; Abrahamsen, Martha; Quiterio, Manuel; Salmeron, Jorge; Lazcano-Ponce, Eduardo

    2015-01-01

    Background Protection from naturally acquired human papillomavirus (HPV) antibodies may influence HPV infection across the lifespan. This study describes seroconversion rates following genital, anal, and oral HPV 6/11/16/18 infections in men and examines differences by HPV type and anatomic site. Methods Men with HPV 6/11/16/18 infections who were seronegative for those genotypes at the time of DNA detection were selected from the HPV Infection in Men (HIM) Study. Sera specimens collected ≤36 months after detection were analyzed for HPV 6/11/16/18 antibodies using a virus-like particle-based ELISA. Time to seroconversion was separately assessed for each anatomic site, stratified by HPV type. Results Seroconversion to ≥1 HPV type (6/11/16/18) in this sub-cohort (N=384) varied by anatomic site, with 6.3, 18.9, and 0.0% seroconverting following anal, genital, and oral HPV infection, respectively. Regardless of anatomic site, seroconversion was highest for HPV 6 (19.3%). Overall, seroconversion was highest following anal HPV 6 infection (69.2%). HPV persistence was the only factor found to influence seroconversion. Conclusions Low seroconversion rates following HPV infection leave men susceptible to recurrent infections that can progress to HPV-related cancers. This emphasizes the need for HPV vaccination in men to ensure immune protection against new HPV infections and subsequent disease. PMID:26688833

  17. 33 CFR 117.445 - Franklin Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Franklin Canal. 117.445 Section 117.445 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.445 Franklin Canal. The draw of the Chatsworth Bridge, mile 4.8 at Franklin, shall...

  18. 33 CFR 117.285 - Grand Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Grand Canal. 117.285 Section 117.285 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Florida § 117.285 Grand Canal. (a) The draw of the Lansing Island bridge, mile 0.7, shall open on...

  19. 33 CFR 117.787 - Gowanus Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Gowanus Canal. 117.787 Section 117.787 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements New York § 117.787 Gowanus Canal. The draws of the Ninth Street Bridge, mile 1.4, the Third...

  20. 33 CFR 117.453 - Houma Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Houma Canal. 117.453 Section 117.453 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.453 Houma Canal. The draw of the S3197 bridge, mile 1.7 at Houma, shall open on signal...

  1. 33 CFR 117.438 - Company Canal.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Company Canal. 117.438 Section 117.438 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.438 Company Canal. (a) The draw of...

  2. 33 CFR 117.438 - Company Canal.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Company Canal. 117.438 Section 117.438 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.438 Company Canal. (a) The draw of...

  3. 33 CFR 117.438 - Company Canal.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Company Canal. 117.438 Section 117.438 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.438 Company Canal. (a) The draw of...

  4. 33 CFR 117.438 - Company Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Company Canal. 117.438 Section 117.438 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.438 Company Canal. (a) The draw of...

  5. 33 CFR 117.438 - Company Canal.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Company Canal. 117.438 Section 117.438 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.438 Company Canal. (a) The draw of...

  6. [Upper lateral incisor with 2 canals].

    PubMed

    Fabra Campos, H

    1991-01-01

    Clinical case summary of the patient with an upper lateral incisor with two root canals. The suspicion that there might be an anatomic anomaly in the root that includes a complex root canal system was made when an advanced radicular groove was detected in the lingual surface or an excessively enlarged cingulum.

  7. 33 CFR 117.444 - Falgout Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Falgout Canal. 117.444 Section 117.444 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.444 Falgout Canal. The draw of the...

  8. Benign lesions of the external auditory canal.

    PubMed

    Tran, L P; Grundfast, K M; Selesnick, S H

    1996-10-01

    Benign mass lesions of the external auditory canal, such as exostoses and osteomas, are common findings on physical examination but most often do not require treatment. The differential diagnosis of lesions in the external auditory canal, however, should not be limited to those benign processes discussed here, but should also include infectious, dermatologic, congenital, and malignant processes.

  9. Metoptic canal, duplication of the optic canal and Warwick’s foramen in human orbits.

    PubMed

    Bertelli, Eugenio

    2014-01-01

    The region of the optic strut is sometimes traversed by some minor canals whose incidence and general characteristics have never been studied. As such canals could be the route for vessels that could interfere in the surgery of the orbital apex, we undertook a detailed anatomical study on a vast collection of dry skulls. The examination of 943 dry adult skulls and 360 foetal skulls was carried out to precise the anatomy of canals in the optic strut area, their development and relationships with the optic canal. A canal traversing the optic strut was present in 8.54 % of the orbits. Based on diameter, position within the optic strut, and thickness of the bony plate separating it from the optic canal or from the superior orbital fissure, the canals piercing the optic strut were classified into four types, which include the well-known duplication of the optic canal, different aspects of the metoptic canal and a type of canal that to our knowledge has never been reported. Warwick’s foramen was found in 0.74 % of orbits. The area of the optic strut is the frequent site of canals joining the orbit with the middle cranial fossa. Some of them can host the ophthalmic artery; others could be run by minor vessels which, however, could be the source of annoying bleedings in surgical procedures.

  10. Tissue engineering in endodontics: root canal revascularization.

    PubMed

    Palit Madhu Chanda; Hegde, K Sundeep; Bhat, Sham S; Sargod, Sharan S; Mantha, Somasundar; Chattopadhyay, Sayan

    2014-01-01

    Root canal revascularization attempts to make necrotic tooth alive by the use of certain simple clinical protocols. Earlier apexification was the treatment of choice for treating and preserving immature permanent teeth that have lost pulp vitality. This procedure promoted the formation of apical barrier to seal the root canal of immature teeth and nonvital filling materials contained within root canal space. However with the success of root canal revascularization to regenerate the pulp dentin complex of necrotic immature tooth has made us to rethink if apexification is at the beginning of its end. The objective of this review is to discuss the new concepts of tissue engineering in endodontics and the clinical steps of root canal revascularization.

  11. Anal intraepithelial neoplasia among HIV-positive men who have sex with men.

    PubMed

    Mata-Marín, José A; Hernández-Figueroa, Jorge; Huerta-García, Gloria; Sandoval-Ramírez, Jorge; Pichardo-Farfán, Miguel; Manjarrez-Tellez, Bulmaro; Ramírez-Mendoza, Pablo; Gaytan-Martínez, Jesús

    2015-11-01

    Neoplasia is the second most common cause of mortality in HIV patients. The prevalence of anal cancer among men who have sex with men (MSM) has continued to increase since the introduction of antiretroviral therapy. We screened 94 HIV-infected MSM patients. We found high-grade squamous intraepithelial lesions (HSIL) in six of the patients. The calculated prevalence of HSIL was 6.4% (95% confidence interval: 2.9-13.2). The study and implementation of screening programs for high-risk groups is a priority.

  12. Silver Clear Nylon Dressing is Effective in Preventing Radiation-Induced Dermatitis in Patients With Lower Gastrointestinal Cancer: Results From a Phase III Study

    SciTech Connect

    Niazi, Tamim M.; Vuong, Te; Azoulay, Laurant; Marijnen, Corrie; Bujko, Kryzstof; Nasr, Elie; Lambert, Christine; Duclos, Marie; Faria, Sergio; David, Marc; Cummings, Bernard

    2012-11-01

    Purpose: For patients with anal canal and advanced rectal cancer, chemoradiation therapy is a curative modality or an important adjunct to surgery. Nearly all patients treated with chemoradiation experience some degree of radiation-induced dermatitis (RID). Prevention and effective treatment of RID, therefore, is of considerable clinical relevance. The present phase III randomized trial compared the efficacy of silver clear nylon dressing (SCND) with that of standard skin care for these patients. Methods and Materials: A total of 42 rectal or anal canal cancer patients were randomized to either a SCND or standard skin care group. SCND was applied from Day 1 of radiation therapy (RT) until 2 weeks after treatment completion. In the control arm, sulfadiazine cream was applied at the time of skin dermatitis. Printed digital photographs taken 2 weeks prior to, on the last day, and two weeks after the treatment completion were scored by 10 blinded readers, who used the common toxicity scoring system for skin dermatitis. Results: The radiation dose ranged from 50.4 to 59.4 Gy, and there were no differences between the 2 groups. On the last day of RT, when the most severe RID occurs, the mean dermatitis score was 2.53 (standard deviation [SD], 1.17) for the standard and 1.67 (SD, 1.2; P=.01) for the SCND arm. At 2 weeks after RT, the difference was 0.39 points in favor of SCND (P=.39). There was considerable intraclass correlation among the 10 observers. Conclusions: Silver clear nylon dressing is effective in reducing RID in patients with lower gastrointestinal cancer treated with combined chemotherapy and radiation treatment.

  13. Looking back at Love Canal

    SciTech Connect

    Deegan, J. Jr.

    1987-04-01

    The comprehensive environmental study which describes the results of a monitoring program conducted by EPA at Love Canal is evaluated by EPA's former study director. Attention is focused on the episode's history and the agency's study methods. The aim of the program was to constitute a study team, design a monitoring study, reprogram and reallocate the financial resources needed to conduct the study, and identify and employ contractors who would collect and analyze environmental samples. The agency was directed to ensure the quality of the data acquired from various environmental media and analyzed by numerous laboratories; to integrate, interpret, and report the data; and to assess, from an environmental perspective, the habitability of the area.

  14. How to bond to root canal dentin

    NASA Astrophysics Data System (ADS)

    Nica, Luminita; Todea, Carmen; Furtos, Gabriel; Baldea, Bogdan

    2014-01-01

    Bonding to root canal dentin may be difficult due to various factors: the structural characteristic of the root canal dentin, which is different from that of the coronal dentin; the presence of the organic tissue of the dental pulp inside the root canal, which has to be removed during the cleaning-shaping of the root canal system; the smear-layer resulted after mechanical instrumentation, which may interfere with the adhesion of the filling materials; the type of the irrigants used in the cleaning protocol; the type of the sealer and core material used in the obturation of the endodontic space; the type of the materials used for the restoration of the endodontically treated teeth. The influence of the cleaning protocol, of the root canal filling material, of the type of the adhesive system used in the restoration of the treated teeth and of the region of the root canal, on the adhesion of several filling and restorative materials to root canal dentin was evaluated in the push-out bond strength test on 1-mm thick slices of endodontically treated human teeth. The results showed that all these factors have a statistically significant influence on the push-out bond strength. Formation of resin tags between radicular dentin and the investigated materials was observed in some of the samples at SEM analysis.

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

    SciTech Connect

    Fraunholz, Ingeborg; Falk, Stefan

    2013-08-01

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

  16. Anterior canal BPPV and apogeotropic posterior canal BPPV: two rare forms of vertical canalolithiasis.

    PubMed

    Califano, L; Salafia, F; Mazzone, S; Melillo, M G; Califano, M

    2014-06-01

    Posterior canal benign paroxysmal positional vertigo (BPPV) is the most frequent form of BPPV. It is characterized by a paroxysmal positioning nystagmus evoked through Dix-Hallpike and Semont positioning tests. Anterior canal BPPV (AC) is more rare than posterior canal BPPV; it presents a prevalent down beating positioning nystagmus, with a torsional component clockwise for the left canal, counterclockwise for the right canal. Due to the possible lack of the torsional component, it is sometimes difficult to identify the affected ear. An apogeotropic variant of posterior BPPV (APC) has recently been described, characterised by a paroxysmal positional nystagmus in the opposite direction to the one evoked in posterior canal BPPV: the linear component is down-beating, the torsional component is clockwise for the right canal, counter-clockwise for the left canal, so that a contra-lateral anterior canal BPPV could be simulated. During a 16 month period, of 934 BPPV patients observed, the authors identified 23 (2.5%) cases of apogeotropic posterior canal BPPV and 11 (1.2%) cases of anterior canal BPPV, diagnosed using the specific oculomotor patterns described in the literature. Anterior canal BPPV was treated with the repositioning manoeuvre proposed by Yacovino, which does not require identification of the affected side, whereas apogeotropic posterior canal BPPV was treated with the Quick Liberatory Rotation manoeuvre for the typical posterior canal BPPV, since in the Dix-Hallpike position otoliths are in the same position if they come either from the ampullary arm or from the non-ampullary arm. The direct resolution of BPPV (one step therapy) was obtained in 12/34 patients, 8/23 patients with APC and 4/11 patients with AC; canalar conversion into typical posterior canal BPPV, later treated through Quick Liberatory Rotation (two-step therapy), was obtained in 19 patients,14/23 with APC and 5/11 with AC. Three patients were lost to follow-up. Considering the effects of

  17. 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

  18. 158. Photocopy of transit book (taken from Twin Falls Canal ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    158. Photocopy of transit book (taken from Twin Falls Canal Company Transit Book #404T, Page 3, #46, Division One). START OF MAIN CANAL SURVEY, TWIN FALLS COUNTY, MILNER, IDAHO. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  19. 154. Photocopy of transit book (taken from Twin Falls Canal ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    154. Photocopy of transit book (taken from Twin Falls Canal Company Surveyor's Transit Book #405T, Page 2, #46 Division One). STATEMENT OF SIGHT-SETTING FOR 1903 SURVEY TO ALIGN SOUTH SIDE CANAL, TWIN FALLS COUNTY, MILNER, IDAHO. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  20. 180. Photocopy of Photograph, Twin Falls Canal Company. E. Pettygro, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    180. Photocopy of Photograph, Twin Falls Canal Company. E. Pettygro, Photographer, date unknown. BLASTING TWIN FALLS CANAL, TWIN FALLS COUNTY; BLASTING COTTONWOOD AREA TO REPLACE FLUME BY RUNNING HIGH LINE THROUGH SOLID ROCK. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  1. 21 CFR 872.3810 - Root canal post.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and...

  2. 21 CFR 872.3810 - Root canal post.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and...

  3. 21 CFR 872.3810 - Root canal post.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and...

  4. 21 CFR 872.3810 - Root canal post.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and...

  5. 21 CFR 872.3810 - Root canal post.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and...

  6. Seepage investigations of Noyes Canal, Menard County, Texas

    USGS Publications Warehouse

    Yost, Ivan Dale

    1953-01-01

    At the request of the U.S. Department of Agriculture, Soil Conservation Service, and the Menard Irrigation Company, a seepage investigation was made on Noyes Canal (Menard Irrigation Company Canal) in Menard County, Texas, from the headgates of the canal to where the canal empties back into the San Saba River.

  7. 3. Dundee Canal looking northwest from north of Dundee Textile ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. Dundee Canal looking northwest from north of Dundee Textile Company Mill - Dundee Canal Industrial Historic District, Beginning at George Street in Passaic & extending north along Dundee Canal approximately 1.2 miles to Canal headgates opposite East Clifton Avenue in Clifton, Passaic, Passaic County, NJ

  8. 7. View north at back (canal side) of culvert inlet, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. View north at back (canal side) of culvert inlet, with canal bank completely removed. Background to foreground: back of inlet headwall with tops of high inlet barrels exposed; vertical transition wall between high inlet barrels and low, interior, inlet barrels; tops of low interior barrels; vertical heartening planks and low cutoff wall at site of former canal edge of canal bank; dewatered canal bed and plank sheathing on top of culvert barrels beneath canal bed. - Delaware & Raritan Canal, Ten Mile Run Culvert, 1.5 miles South of Blackwells Road, East Millstone, Somerset County, NJ

  9. 8. VIEW SHOWING THE DEMOSSING OF GRAND CANAL LOCATION UNKNOWN. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. VIEW SHOWING THE DEMOSSING OF GRAND CANAL LOCATION UNKNOWN. AT TEAM OF HORSES ON OPPOSITE BANKS OF THE CANAL DRAG A CHAIN BETWEEN THEM ALONG THE BOTTOM OF THE CANAL, WHICH PULLS THE MOSS AND WEEDS LOOSE. THE PLANS THEN FLOAT DOWN THE CANAL AND ARE CAUGHT IN A SCREEN AND REMOVED. Photographer unknown, 1923 - Grand Canal, North side of Salt River, Tempe, Maricopa County, AZ

  10. CT appearances of external ear canal cholesteatoma.

    PubMed

    Malcolm, P N; Francis, I S; Wareing, M J; Cox, T C

    1997-09-01

    External ear canal cholesteatoma (EECC) is rare in ear, nose and throat (ENT) practice. Two cases, one bilateral, are described. Computed tomography demonstrates the extent of bony involvement. Erosion of the external canal should not be overlooked when reviewing CT of the petrous bone in cases of discharge from the ear. EECC may necessitate surgery and delay in the diagnosis of EECC can result in progressive bony destruction.

  11. Mechanics of the Panama Canal slides

    USGS Publications Warehouse

    Becker, George F.

    1917-01-01

    Dr. Becker visited the Canal Zone in 1913 as a geologist of the United States Geological Survey and since that time has given the problem the benefit of his study. His appointment as a member of the committee of the National Academy of Sciences has made it appropriate for his conclusions, based upon his personal observations and already reported in part to the Canal Commission, to be stated for the benefit of his associates and other American scientists and engineers.

  12. Disinfection of Contaminated Canals by Different Laser Wavelengths, while Performing Root Canal Therapy.

    PubMed

    Asnaashari, Mohammad; Safavi, Nassimeh

    2013-01-01

    Removal of smear layer and disinfection of canals are important objectives of teeth root canal cleaning. In order to achieve this purpose, rinsing substances, intra canal drugs as well as ultrasound are used. Today, use of laser to remove smear layer and to disinfect root canals has increasingly attracted the attentions. Till now different lasers such as CO2, Nd:YAG, Er:YAG, Er,Cr:YSGG have been used for debris and smear removal from the canals. Numerous studies have shown that Er:YAG is the most appropriate laser for intra canal debris and smear removal. In addition different laser wavelengths have been used directly or as an adjunctive to disinfect canals. Laser light can penetrate areas of canals where irrigating and disinfecting solutions cannot reach, like secondary canals and deep dentinal tubules and also can eliminate microorganisms. Different studies have confirmed the penetration of Nd:YAG laser in deep dentin and reduction of microorganisms penetration. But studies on comparison of antibacterial effects of Nd:YAG laser with sodium hypochlorite showed effectiveness of both, with a better effect for sodium hypochlorite. Studies performed in relation with anti-microbial effects of Diode laser with various parameters show that this laser can be effective in reducing intra canal bacterial count and penetration in the depth of 500 microns in dentin. In studies performed on Diode laser in combination with canal irrigating solutions such as sodium hypochlorite and oxygenated water better results were obtained. Although studies on disinfection by the Erbium laser family show that use of this laser alone can be effective in disinfecting canals, studies evaluating the disinfecting effects of this laser and different concentrations of sodium hypochlorite show that the latter alone is more effective in disinfecting canals. And better results were obtained when Erbium laser was used in combination with sodium hypochlorite irrigating solution in canals. Results of the

  13. No evidence of NRAS mutation in squamous cell anal carcinoma (SCAC)

    PubMed Central

    Capelli, Laura; Casadei Gardini, Andrea; Scarpi, Emanuela; Frassineti, Giovanni Luca; Saragoni, Luca; Puccetti, Maurizio; Scartozzi, Mario; Giannini, Massimo; Tamberi, Stefano; Corbelli, Jody; Ulivi, Paola

    2016-01-01

    Epidermal growth factor receptor (EGFR) is usually expressed in squamous cell anal carcinoma (SCAC) and anti-EGFR agents could represent a valid treatment strategy, also considering that KRAS and BRAF mutations are rare events in this type of cancer. However, no data are available on NRAS status in SCAC. In this study we analyzed NRAS status (exons 2–4) by Pyrosequencing in a case series of 50 SCAC patients previously characterized in our laboratory for KRAS, BRAF, PIK3CA mutations and HPV and HIV infections. We found no mutation in NRAS gene. These results confirm that since the principal anti-EGFR resistance mechanisms are almost absent in SCAC, anti-EGFR agents should be considered for the treatment of this type of cancer. PMID:27886225

  14. The fluid mechanics of root canal irrigation.

    PubMed

    Gulabivala, K; Ng, Y-L; Gilbertson, M; Eames, I

    2010-12-01

    Root canal treatment is a common dental operation aimed at removing the contents of the geometrically complex canal chambers within teeth; its purpose is to remove diseased or infected tissue. The complex chamber is first enlarged and shaped by instruments to a size sufficient to deliver antibacterial fluids. These irrigants help to dissolve dying tissue, disinfect the canal walls and space and flush out debris. The effectiveness of the procedure is limited by access to the canal terminus. Endodontic research is focused on finding the instruments and clinical procedures that might improve success rates by more effectively reaching the apical anatomy. The individual factors affecting treatment outcome have not been unequivocally deciphered, partly because of the difficulty in isolating them and in making the link between simplified, general experimental models and the complex biological objects that are teeth. Explicitly considering the physical processes within the root canal can contribute to the resolution of these problems. The central problem is one of fluid motion in a confined geometry, which makes the dispersion and mixing of irrigant more difficult because of the absence of turbulence over much of the canal volume. The effects of treatments can be understood through the use of scale models, mathematical modelling and numerical computations. A particular concern in treatment is that caustic irrigant may penetrate beyond the root canal, causing chemical damage to the jawbone. In fact, a stagnation plane exists beyond the needle tip, which the irrigant cannot penetrate. The goal is therefore to shift the stagnation plane apically to be coincident with the canal terminus without extending beyond it. Needle design may solve some of the problems but the best design for irrigant penetration conflicts with that for optimal removal of the bacterial biofilm from the canal wall. Both irrigant penetration and biofilm removal may be improved through canal fluid

  15. The Anal Pap Smear: Cytomorphology of squamous intraepithelial lesions.

    PubMed

    Arain, Shehla; Walts, Ann E; Thomas, Premi; Bose, Shikha

    2005-02-16

    BACKGROUND: Anal smears are increasingly being used as a screening test for anal squamous intraepithelial lesions (ASILs). This study was undertaken to assess the usefulness and limitations of anal smears in screening for ASILs. METHODS: The cytomorphological features of 200 consecutive anal smears collected in liquid medium from 198 patients were studied and findings were correlated with results of surgical biopsies and/or repeat smears that became available for 71 patients within six months. RESULTS: Adequate cellularity was defined as an average of 6 or more nucleated squamous cells/hpf. A glandular/transitional component was not required for adequacy. Dysplastic cells, atypical parakeratotic cells and bi/multinucleated cells were frequent findings in ASIL while koilocytes were infrequent. Smears from LSIL cases most frequently showed mildly dysplastic and bi/multinucleate squamous cells followed by parakeratotic cells (PK), atypical parakeratotic cells (APK), and koilocytes. HSIL smears contained squamous cells with features of moderate/severe dysplasia and many APKs. Features of LSIL were also found in most HSIL smears. CONCLUSIONS: In this study liquid based anal smears had a high sensitivity (98%) for detection of ASIL but a low specificity (50%) for predicting the severity of the abnormality in subsequent biopsy. Patients with cytologic diagnoses of ASC-US and LSIL had a significant risk (46-56%) of HSIL at biopsy. We suggest that all patients with a diagnosis of ASC-US and above be recommended for high resolution anoscopy with biopsy.

  16. All's Well That Ends Well: Shakespeare's treatment of anal fistula.

    PubMed

    Cosman, B C

    1998-07-01

    Textual and contextual evidence suggests that the French king's fistula, a central plot device in Shakespeare's play All's Well That Ends Well, is a fistula-in-ano. Anal fistula was known to the lay public in Shakespeare's time. In addition, Shakespeare may have known of the anal fistula treatise of John Arderne, an ancestor on Shakespeare's mother's side. Shakespeare's use of anal fistula differs from all previous versions of the story, which first appeared in Boccaccio's Decameron and from its possible historical antecedent, the fistula of Charles V of France. This difference makes sense given the conventions of Elizabethan comedy, which included anal humor. It is also understandable when one looks at what wounds in different locations mean in European legend. In this light, it is not surprising that subsequent expurgations treat Boccaccio's and Shakespeare's fistulas differently, censoring only Shakespeare's. This reading has implications for the staging of All's Well That Ends Well, and for our view of the place of anal fistulas in cultural history.

  17. [A case of primary carcinoma associated with anal fistula].

    PubMed

    Nushijima, Youichirou; Nakano, Katsutoshi; Sugimoto, Keishi; Nakaguchi, Kazunori; Kan, Kazuomi; Maruyama, Hirohide; Doi, Sadayuki; Okamura, Shu; Murata, Kohei

    2014-11-01

    A 47-year-old man with no history of anal fistula was admitted to our hospital with a complaint of perianal pain. Computed tomography (CT) imaging revealed perianal abscess. Incision and drainage were performed under spinal anesthesia. Ten months after drainage, magnetic resonance imaging revealed anal fistula on the left side of the anus. Subsequently, core-out and seton procedures were performed for ischiorectalis type III anal fistula. Pathological examination of the resected specimen of anal fistula revealed a moderately differentiated adenocarcinoma, leading to the diagnosis of carcinoma associated with anal fistula. No distant metastases or enlarged lymph nodes were observed on positron emission tomography (PET)/CT. We performed abdominoperineal resection with wide resection of ischiorectalis fat tissue. The pathology results were tub2, A, ly0, v0, n0, PM0, DM0, RM0, H0, P0, M0, Stage II. Negative pressure wound therapy was performed for perineum deficiency, after which rapid wound healing was observed. Left inguinal lymph node recurrence was detected 8 months after surgery, for which radiotherapy was administered. Distant metastasis was detected 11 months after surgery. The patient died 21 months after surgery.

  18. Polypoid anal melanoma. A case report and review of the literature.

    PubMed

    Tutino, Roberta; Clerico, Giuseppe; Luc, Alberto Realis; Gallo, Gaetano; Trompetto, Mario

    2016-11-12

    Il melanoma ano-rettale è una patologia rara, rappresentando l’1% dei tumori anali e lo 0.4-1.6% dei melanomi. I suoi sintomi sono simili a quelli delle più comuni malattie benigne della regione anorettale, portando spesso a diagnosi in stadi avanzati, in particolare se la sede del tumore è a livello del canale anale. In ogni caso la prognosi del melanoma anorettale rimane severa con una sopravvivenza a 5 anni che non supera il 22% negli stadi più precoci. La letteratura presenta saltuarie serie monocentriche ed alcuni case report e a tutt’oggi non vi sono linee-guida per il suo management. La classificazione più usata divide la malattia in tre stadi a seconda del coinvolgimento o meno dei linfonodi regionali e della presenza di metastasi a distanza. Un’analisi di popolazione ha mostrato una sopravvivenza a 5 anni del 17%, 18% e 5% rispettivamente per i tre stadi di malattia dopo chirurgia e dello 0%, 0% e 4% in assenza di trattamento. La risonanza magnetica e l’ecoendoscopia sono utili per la valutazione di operabilità locale mentre la TAC e la PET sono indicati per la valutazione di eventuali metastasi a distanza. I fattori di rischio per recidiva sono l’invasione perineurale, la necrosi tumorale, dimensioni superiori a 2 cm ed un’istologia con cellule fusate o miste. I protocolli poli-chemioterapici utilizzati sinora per il melanoma anorettale hanno purtroppo portato a risultati meno soddisfacenti di quelli ottenuti nel trattamento del melanoma cutaneo. La mutazione del c-KIT ed i trattamenti con i suoi inibitori sembrano dimostrare risultati promettenti mentre la radioterapia non sembra attualmente rivestire alcun ruolo terapeutico rilevante. Abbiamo riportato il caso di una donna di 55 anni visitata presso un ambulatorio di coloproctologia per rettorragia saltuaria ed un dolore anale che ha reso impossibile la valutazione clinica locale. La valutazione in anestesia ha rivelato la presenza di una massa polipoide di colorito brunastro del

  19. Identification of Episomal Human Papillomavirus and Other DNA Viruses in Cytological Anal Samples of HIV-Uninfected Men Who Have Sex with Men

    PubMed Central

    Benevolo, Maria; Vocaturo, Amina; Latini, Alessandra; Giglio, Amalia; Venuti, Aldo; Giuliani, Massimo

    2013-01-01

    To date, there have been only few studies that investigated integration of anal Human Papillomavirus (HPV). Most of them were conducted on HIV-infected individuals and mainly analyzed samples from high-grade lesions and invasive cancer. We aimed to investigate HPV physical status in HIV-negative men who have sex with men (MSM) with a detectable anal HPV infection, irrespective of the presence of lesions. We also sought to explore the presence of other circular DNA viruses in the anal region. Study participants were attendees of an STI screening program, which were also screened for anal HPV infection and cytological abnormalities. HPV physical status was assessed using multiply-primed RCA. HPV16-positive samples were also analyzed using E2/E6 multiplex PCR, qRT-PCR and APOT assay. RCA and virus-specific PCR were employed to investigate the presence of other DNA viruses. Anal HPV infection was detected in 76.9% of the 230 MSM enrolled. The anal cytological reports were: 129 NILM, 37 ASC-US and 28 L-SIL (36 samples were inadequate for interpretation). HPV physical status was evaluated in the 109 anal specimens that harbored one or two different HPV genotypes. Integration was observed only in one HPV16-positive sample (0.9%), in which integrate-derived viral transcripts of type B were detected. Integration occurred in chromosome 14 q. In 22 of the 53 (41.5%) mucosal HPV-negative samples, RCA restriction results would seem to indicate the presence of circular DNA viruses. Indeed, cutaneous HPV (4 samples), MCPyV (5 samples) and TTV (4 samples) were detected. In conclusion, anal HPV integration was rarely evidenced in HIV-uninfected MSM with no or mild anal cytological abnormalities, although the integration rate may have been underestimated because of the limitations of the employed assays. Other DNA viruses were detected in the anal samples of these individuals, although the significance of this occurrence needs to be assessed. PMID:23951299

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

    PubMed

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

    2013-01-01

    To date, there have been only few studies that investigated integration of anal Human Papillomavirus (HPV). Most of them were conducted on HIV-infected individuals and mainly analyzed samples from high-grade lesions and invasive cancer. We aimed to investigate HPV physical status in HIV-negative men who have sex with men (MSM) with a detectable anal HPV infection, irrespective of the presence of lesions. We also sought to explore the presence of other circular DNA viruses in the anal region. Study participants were attendees of an STI screening program, which were also screened for anal HPV infection and cytological abnormalities. HPV physical status was assessed using multiply-primed RCA. HPV16-positive samples were also analyzed using E2/E6 multiplex PCR, qRT-PCR and APOT assay. RCA and virus-specific PCR were employed to investigate the presence of other DNA viruses. Anal HPV infection was detected in 76.9% of the 230 MSM enrolled. The anal cytological reports were: 129 NILM, 37 ASC-US and 28 L-SIL (36 samples were inadequate for interpretation). HPV physical status was evaluated in the 109 anal specimens that harbored one or two different HPV genotypes. Integration was observed only in one HPV16-positive sample (0.9%), in which integrate-derived viral transcripts of type B were detected. Integration occurred in chromosome 14 q. In 22 of the 53 (41.5%) mucosal HPV-negative samples, RCA restriction results would seem to indicate the presence of circular DNA viruses. Indeed, cutaneous HPV (4 samples), MCPyV (5 samples) and TTV (4 samples) were detected. In conclusion, anal HPV integration was rarely evidenced in HIV-uninfected MSM with no or mild anal cytological abnormalities, although the integration rate may have been underestimated because of the limitations of the employed assays. Other DNA viruses were detected in the anal samples of these individuals, although the significance of this occurrence needs to be assessed.

  1. Application of software for automated canal management (SacMan) to the WM lateral canal

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Simulation studies have demonstrated that automatic control of canals is more effective when feedforward scheduling, or routing of know demand changes, is combined with centralized, automatic, distant, downstream-water-level control. In practice, few canals use this approach. To help further develop...

  2. 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?

  3. Treatment of peri-anal fistula in Crohn's disease

    PubMed Central

    Sica, Giuseppe S; Di Carlo, Sara; Tema, Giorgia; Montagnese, Fabrizio; Del Vecchio Blanco, Giovanna; Fiaschetti, Valeria; Maggi, Giulia; Biancone, Livia

    2014-01-01

    Anal fistulas are a common manifestation of Crohn’s disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently employed. However, at the moment, none of these techniques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medical therapy and those causing disabling symptoms. Utmost attention should be paid to correcting the balance between eradication of the fistula and the preservation of fecal continence. PMID:25309057

  4. Anal sphincter dysfunction in multiple sclerosis: an observation manometric study.

    PubMed

    Marola, Silvia; Ferrarese, Alessia; Gibin, Enrico; Capobianco, Marco; Bertolotto, Antonio; Enrico, Stefano; Solej, Mario; Martino, Valter; Destefano, Ines; Nano, Mario

    2016-01-01

    Constipation, obstructed defecation, and fecal incontinence are frequent complaints in multiple sclerosis. The literature on the pathophysiological mechanisms underlying these disorders is scant. Using anorectal manometry, we compared the anorectal function in patients with and without multiple sclerosis. 136 patients referred from our Center for Multiple Sclerosis to the Coloproctology Outpatient Clinic, between January 2005 and December 2011, were enrolled. The patients were divided into four groups: multiple sclerosis patients with constipation (group A); multiple sclerosis patients with fecal incontinence (group B); non-multiple sclerosis patients with constipation (group C); non-multiple sclerosis patients with fecal incontinence (group D). Anorectal manometry was performed to measure: resting anal pressure; maximum squeeze pressure; rectoanal inhibitory reflex; filling pressure and urge pressure. The difference between resting anal pressure before and after maximum squeeze maneuvers was defined as the change in resting anal pressure calculated for each patient.

  5. Squamous cell carcinoma of the anal sac in five dogs.

    PubMed

    Esplin, D G; Wilson, S R; Hullinger, G A

    2003-05-01

    Tumors of the perianal area of dogs are common and include multiple tumor types. Whereas perianal adenomas occur often, adenocarcinomas of the apocrine glands of the anal sac occur less frequently. A review of the literature revealed no reports of squamous cell carcinomas arising from the epithelial lining of the anal sac. Squamous cell carcinomas originating from the lining of the anal sac were diagnosed in five dogs. Microscopically, the tumors consisted of variably sized invasive nests and cords of epithelial cells displaying squamous differentiation. Four of the five dogs were euthanatized because of problems associated with local infiltration by the tumors. In the fifth dog, there was no evidence of tumor 7 months after surgical removal, but further follow up was not available.

  6. [Management of complications in anal and transanal tumor surgery].

    PubMed

    Sailer, M; Eisoldt, S; Möllmann, C

    2015-08-01

    Anal and transanal tumor operations are safe and are associated with a very low morbidity. Perianal and anal lesions as well as low rectal tumors can be excised by direct exposure using an anal retractor. For lesions situated in the middle or upper third of the rectum, special instrumentation, such as transanal endoscopic microsurgery (TEM) and transanal endoscopic operation (TEO) should be used to avoid unnecessary R1 resections. Fatal complications are extremely rare and most complications, such as urinary retention or temporary subfebrile temperatures, are minor. Suture line dehiscences are usually clinically unremarkable. Major complications comprise significant hemorrhage and opening of the peritoneal cavity. The latter must be recognized intraoperatively and can usually be managed by primary suturing. Infections, abscess formation, rectovaginal fistula, injury of the prostate or even urethra are extremely rare complications.

  7. Volatile compounds from anal glands of the wolverine, Gulo gulo.

    PubMed

    Wood, William F; Terwilliger, Miranda N; Copeland, Jeffrey P

    2005-09-01

    Dichloromethane extracts of wolverine (Gulo gulo, Mustelinae, Mustelidae) anal gland secretion were examined by gas chromatography-mass spectrometry. The secretion composition was complex and variable for the six samples examined: 123 compounds were detected in total, with the number per animal ranging from 45 to 71 compounds. Only six compounds were common to all extracts: 3-methylbutanoic acid, 2-methylbutanoic acid, phenylacetic acid, alpha-tocopherol, cholesterol, and a compound tentatively identified as 2-methyldecanoic acid. The highly odoriferous thietanes and dithiolanes found in anal gland secretions of some members of the Mustelinae [ferrets, mink, stoats, and weasels (Mustela spp.) and zorillas (Ictonyx spp.)] were not observed. The composition of the wolverine's anal gland secretion is similar to that of two other members of the Mustelinae, the pine and beech marten (Martes spp.).

  8. Treatment of peri-anal fistula in Crohn's disease.

    PubMed

    Sica, Giuseppe S; Di Carlo, Sara; Tema, Giorgia; Montagnese, Fabrizio; Del Vecchio Blanco, Giovanna; Fiaschetti, Valeria; Maggi, Giulia; Biancone, Livia

    2014-10-07

    Anal fistulas are a common manifestation of Crohn's disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently employed. However, at the moment, none of these techniques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medical therapy and those causing disabling symptoms. Utmost attention should be paid to correcting the balance between eradication of the fistula and the preservation of fecal continence.

  9. Human papillomavirus-associated cancers: A growing global problem

    PubMed Central

    Bansal, Anshuma; Singh, Mini P; Rai, Bhavana

    2016-01-01

    Human papillomavirus (HPV) infection is linked with several cancers such as cancer cervix, vagina, vulva, head and neck, anal, and penile carcinomas. Although there is a proven association of HPV with these cancers, questions regarding HPV testing, vaccination, and treatment of HPV-related cancers continue to remain unanswered. The present article provides an overview of the HPV-associated cancers. PMID:27127735

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

    PubMed

    Cariati, Andrea

    2013-09-01

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

  11. Why do we have so much trouble treating anal fistula?

    PubMed

    Dudukgian, Haig; Abcarian, Herand

    2011-07-28

    Anal fistula is among the most common illnesses affecting man. Medical literature dating back to 400 BC has discussed this problem. Various causative factors have been proposed throughout the centuries, but it appears that the majority of fistulas unrelated to specific causes (e.g. Tuberculosis, Crohn's disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces. The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases. The problem with this single, yet effective, treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses, the patient will have varying degrees of fecal incontinence from minor to total. In an attempt to preserve continence, various procedures have been proposed to deal with the fistulas. These include: (1) simple drainage (Seton); (2) closure of fistula tract using fibrin sealant or anal fistula plug; (3) closure of primary opening using endorectal or dermal flaps, and more recently; and (4) ligation of intersphincteric fistula tract (LIFT). In most complex cases (i.e. Crohn's disease), a proximal fecal diversion offers a measure of symptomatic relief. The fact remains that an "ideal" procedure for anal fistula remains elusive. The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations. In essence, the price of preservation of continence at all cost is multiple and often different operations, prolonged disability and disappointment for the patient and the surgeon. Nevertheless, the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist. Conversely, an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.

  12. Preceramic irrigation canals in the Peruvian Andes.

    PubMed

    Dillehay, Tom D; Eling, Herbert H; Rossen, Jack

    2005-11-22

    One of the most important developments in the existence of human society was the successful shift from a subsistence economy based on foraging to one primarily based on food production derived from cultivated plants and domesticated animals. The shift to plant food production occurred in only a few independent centers around the world and involved a commitment to increased sedentism and social interaction and to permanent agricultural fields and canals. One center was Peru, where early civilization and food production were beginning to develop by at least 4,500 years ago. New archeological evidence points to 5,400- and possible 6,700-year-old small-scale gravity canals in a circumscribed valley of the western Andean foothills in northern Peru that are associated with farming on low terrace benches at the foot of alluvial fans in areas where the canals are drawn from hydraulically manageable small lateral streams. This evidence reveals early environmental manipulation and incipient food production in an artificially created wet agroecosystem rather than simply the intensive harvesting or gardening of plants in moist natural areas. This finding is different from previously conceived notions, which expected early canals in lower-elevated, broad coastal valleys. The evidence also points to communal organization of labor to construct and maintain the canals and to the scheduling of daily activities beyond individual households. The development of early organized irrigation farming was combined with a hunting and gathering economy to support an increase in the local population size.

  13. Preceramic irrigation canals in the Peruvian Andes

    PubMed Central

    Dillehay, Tom D.; Eling, Herbert H.; Rossen, Jack

    2005-01-01

    One of the most important developments in the existence of human society was the successful shift from a subsistence economy based on foraging to one primarily based on food production derived from cultivated plants and domesticated animals. The shift to plant food production occurred in only a few independent centers around the world and involved a commitment to increased sedentism and social interaction and to permanent agricultural fields and canals. One center was Peru, where early civilization and food production were beginning to develop by at least 4,500 years ago. New archeological evidence points to 5,400- and possible 6,700-year-old small-scale gravity canals in a circumscribed valley of the western Andean foothills in northern Peru that are associated with farming on low terrace benches at the foot of alluvial fans in areas where the canals are drawn from hydraulically manageable small lateral streams. This evidence reveals early environmental manipulation and incipient food production in an artificially created wet agroecosystem rather than simply the intensive harvesting or gardening of plants in moist natural areas. This finding is different from previously conceived notions, which expected early canals in lower-elevated, broad coastal valleys. The evidence also points to communal organization of labor to construct and maintain the canals and to the scheduling of daily activities beyond individual households. The development of early organized irrigation farming was combined with a hunting and gathering economy to support an increase in the local population size. PMID:16284247

  14. Tooth anatomy risk factors influencing root canal working length accessibility

    PubMed Central

    Tang, Lu; Sun, Tuo-qi; Gao, Xiao-jie; Zhou, Xue-dong; Huang, Ding-ming

    2011-01-01

    The aim of this study was to analyze the specific influence of root canal anatomy on the accessibility of working length during root canal therapy. Four hundred seventy-six root canal therapy cases (amounting to a total of 1 005 root canals) were examined. The anatomy risk factors assessed in each case included: tooth type (tooth location), root canal curvature, and root canal calcification, as well as endodontic retreatment. The investigation examined the correlation between each of these anatomic factors and the working length, with statistical analysis consisting of Chi-square tests and multiple logistic regression analysis. In an independent factor analysis, tooth type (tooth location), root canal curvature, canal calcification, and endodontic retreatment were determined to be the primary risk factors. In a multiple-factor regression model, root curvature and canal calcification were found to most significantly influence root canal working length accessibility (P<0.05). Root canal anatomy increases the difficulty of root canal preparation. Appropriate consideration of tooth anatomy will assist in accurate determination of preparation difficulty before instrumentation. This study alerts clinical therapists to anatomical factors influencing the working length accessibility, and allows for a direct estimate of success rate given in situ measurements of tooth factors during the root canal treatment procedure. PMID:21789962

  15. Acute Toxicity After Image-Guided Intensity Modulated Radiation Therapy Compared to 3D Conformal Radiation Therapy in Prostate Cancer Patients

    SciTech Connect

    Wortel, Ruud C.; Incrocci, Luca; Pos, Floris J.; Lebesque, Joos V.; Witte, Marnix G.; Heide, Uulke A. van der; Herk, Marcel van; Heemsbergen, Wilma D.

    2015-03-15

    Purpose: Image-guided intensity modulated radiation therapy (IG-IMRT) allows significant dose reductions to organs at risk in prostate cancer patients. However, clinical data identifying the benefits of IG-IMRT in daily practice are scarce. The purpose of this study was to compare dose distributions to organs at risk and acute gastrointestinal (GI) and genitourinary (GU) toxicity levels of patients treated to 78 Gy with either IG-IMRT or 3D-CRT. Methods and Materials: Patients treated with 3D-CRT (n=215) and IG-IMRT (n=260) receiving 78 Gy in 39 fractions within 2 randomized trials were selected. Dose surface histograms of anorectum, anal canal, and bladder were calculated. Identical toxicity questionnaires were distributed at baseline, prior to fraction 20 and 30 and at 90 days after treatment. Radiation Therapy Oncology Group (RTOG) grade ≥1, ≥2, and ≥3 endpoints were derived directly from questionnaires. Univariate and multivariate binary logistic regression analyses were applied. Results: The median volumes receiving 5 to 75 Gy were significantly lower (all P<.001) with IG-IMRT for anorectum, anal canal, and bladder. The mean dose to the anorectum was 34.4 Gy versus 47.3 Gy (P<.001), 23.6 Gy versus 44.6 Gy for the anal canal (P<.001), and 33.1 Gy versus 43.2 Gy for the bladder (P<.001). Significantly lower grade ≥2 toxicity was observed for proctitis, stool frequency ≥6/day, and urinary frequency ≥12/day. IG-IMRT resulted in significantly lower overall RTOG grade ≥2 GI toxicity (29% vs 49%, respectively, P=.002) and overall GU grade ≥2 toxicity (38% vs 48%, respectively, P=.009). Conclusions: A clinically meaningful reduction in dose to organs at risk and acute toxicity levels was observed in IG-IMRT patients, as a result of improved technique and tighter margins. Therefore reduced late toxicity levels can be expected as well; additional research is needed to quantify such reductions.

  16. [Anal verruciform xanthoma in a transplant background for primary hyperoxaluria. Anal verruciform xanthoma after a combined hepato-renal transplantation].

    PubMed

    Moktefi, Anissa; De Parades, Vincent; Fléjou, Jean-François

    2013-10-01

    We report a case of anal verruciform xanthoma in a patient who underwent a combined liver and kidney transplantation for primary hyperoxaluria. Verruciform xanthoma is a rare and benign lesion arising in oral cavity and genital mucosa. It is characterized pathologically by papillary epithelial hyperplasia and aggregates of foamy macrophages in connective tissue papillae. This condition, whose pathogenesis remains unclear, has been reported in immunosuppressive background or associated with underlying dermatosis. We report here the second case of anal verruciform xanthoma. To our knowledge, this is the first report of verruciform xanthoma in association with primary hyperoxaluria.

  17. Low-frequency otolith and semicircular canal interactions after canal inactivation

    NASA Technical Reports Server (NTRS)

    Angelaki, D. E.; Merfeld, D. M.; Hess, B. J.

    2000-01-01

    During sustained constant velocity and low-frequency off-vertical axis rotations (OVAR), otolith signals contribute significantly to slow-phase eye velocity. The adaptive plasticity of these responses was investigated here after semicircular canal plugging. Inactivation of semicircular canals results in a highly compromised and deficient vestibulo-ocular reflex (VOR). Based on the VOR enhancement hypothesis, one could expect an adaptive increase of otolith-borne angular velocity signals due to combined otolith/canal inputs after inactivation of the semicircular canals. Contrary to expectations, however, the steady-state slow-phase velocity during constant velocity OVAR decreased in amplitude over time. A similar progressive decrease in VOR gain was also observed during low-frequency off-vertical axis oscillations. This response deterioration was present in animals with either lateral or vertical semicircular canals inactivated and was limited to the plane(s) of the plugged canals. The results are consistent with the idea that the low-frequency otolith signals do not simply enhance VOR responses. Rather, the nervous system appears to correlate vestibular sensory information from the otoliths and the semicircular canals to generate an integral response to head motion.

  18. Safety and Immune Response to a Multi-component Immune Based Therapy (MKC1106-PP) for Patients With Advanced Cancer.

    ClinicalTrials.gov

    2010-08-02

    Ovarian; Melanoma; Renal; Prostate; Colorectal; Endometrial Carcinoma; Cervical Carcinoma; Testicular Cancer; Thyroid Cancer; Small Cell Lung Carcinoma; Mesothelioma; Breast Carcinoma; Esophageal Carcinoma; Gastric Cancer; Pancreatic Carcinoma; Neuroendocrine Cancer; Liver Cancer; Gallbladder Cancer; Biliary Tract Cancer; Anal Carcinoma; Bone Sarcomas; Soft Tissue Sarcomas; Carcinoma of Unknown Origin, Primary

  19. Accurate Measurement of Canal Length during Root Canal Treatment: An In Vivo Study

    PubMed Central

    Sadaf, Durre; Ahmad, Muhammad Zubair

    2015-01-01

    Objectives: To assess the consistency and accuracy of Electronic Apex Locator (EAL) (Root ZXII) in individual canals and its association with other clinical variables. Study Design: Cross-Sectional study. Place of study: Dental section of the Aga Khan University Hospital, Karachi, Pakistan. Materials and Methods: Working length was measured by EAL in 180 patients requiring endodontic therapy in molar and premolar teeth. The effects of clinical variables e.g. gender and pulpal status on the consistency and accuracy of EAL were recorded. Performance of apex locator was considered “Consistent” when the scale bar was stable and moved only in correspondence to the movement of file in the root canal. Accuracy was determined by inserting the file at the working length determined by the EAL and periapical view of radiograph was taken using paralleling technique. Estimated working length was considered accurate when the file tip was located 0-2mm short of the radiographic apex. If the file was overextended from the radiographic apex, it showed dysfunction of the EAL. Results: Consistency of EAL was found 97.6% in distobuccal canals, 91.1% in palatal canals, 73.7% in mesiolingual canals, 83.3% in mesiobuccal and 80.2% in distal canals. Accuracy of EAL was 91.4% in mesiolingual canal, 92% in mesiobuccal, and 90.2% in Palatal and 93.2% in distal canal. Conclusion: Consistency of electronic apex locator vary in different canals, however consistent measurements are highly accurate. No significant association was found between other clinical variables with the consistency and accuracy of EAL.

  20. Polyacrylamide Transport in Water Delivery Canals

    NASA Astrophysics Data System (ADS)

    Chen, L.; Zhu, J.; Young, M.

    2007-12-01

    Linear, anionic polyacrylamide (PAM) is being considered in the western United States as a technology to reduce seepage in unlined water delivery canals. A broad laboratory and field testing program has been undertaken to understand the benefits and potential environmental impacts of PAM use. The ability to predict the fate and transport of PAM in water delivery canals could prove to be a useful planning tool for PAM application. However, one key area of uncertainty of this type of canal treatment is the hydration, reaction, and settling rates of PAM after the dry powder is added to the canal water. In this study, we have developed a model that incorporates a number of known physical and chemical processes that can affect PAM transport, such as convection, dispersion, dissolution, flocculation, and settling, while solving the governing convection-dispersion transport equation. The model uses a mixed analytical and advanced numerical approach, and implements a transient partitioning of PAM mass between the canal water, the substrate soil, and potentially to open water bodies downstream of the application point. All source terms are modeled based on physical and chemical mechanisms as well as laboratory or field determined parameters. To more closely simulate field treatment of some canals, where PAM application moves upstream in time, the model is capable of implementing either a fixed or mobile upper boundary. In the latter treatment, the PAM can be added discretely or continuously in both time and space. A number of test situations have been simulated thus far, including theoretical and hypothetical cases for a wide range of conditions. The model also performed well when predicting PAM concentrations from a full-scale canal treatment experiment. The model provides a useful tool for predicting PAM fate and transport in water delivery canals, and therefore can play an important role in evaluating the efficacy of PAM application for water resources management

  1. 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.

  2. OVERALL VIEW OF CASCADE CANAL COMPANY CRIB DAM, LOOKING UPSTREAM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    OVERALL VIEW OF CASCADE CANAL COMPANY CRIB DAM, LOOKING UPSTREAM FROM DIRECTION OF KACHESS DAM. VIEW TO NORTH - Kachess Dam, 1904 Cascade Canal Company Crib Dam, Kachess River, 1.5 miles north of Interstate 90, Easton, Kittitas County, WA

  3. CANAL EXITING FLUME AND BEGINNING EARTHLINED MAIN SECTION AT MOUTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    CANAL EXITING FLUME AND BEGINNING EARTH-LINED MAIN SECTION AT MOUTH OF PLATTE RIVER CANYON. VIEW TO WEST - High Line Canal, Mouth of South Platte River to confluence with Second Creek, Denver, Denver County, CO

  4. 77. ROOSEVELT POWER CANAL LOCATION MAP, WORK TO BE DONE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    77. ROOSEVELT POWER CANAL LOCATION MAP, WORK TO BE DONE BY CONTRACT Courtesy of Dept. of the Interior, Bureau of Reclamation, Salt River Project - Roosevelt Power Canal & Diversion Dam, Parallels Salt River, Roosevelt, Gila County, AZ

  5. Stratification and enumeration of Boolean functions by canalizing depth

    NASA Astrophysics Data System (ADS)

    He, Qijun; Macauley, Matthew

    2016-01-01

    Boolean network models have gained popularity in computational systems biology over the last dozen years. Many of these networks use canalizing Boolean functions, which has led to increased interest in the study of these functions. The canalizing depth of a function describes how many canalizing variables can be recursively "picked off", until a non-canalizing function remains. In this paper, we show how every Boolean function has a unique algebraic form involving extended monomial layers and a well-defined core polynomial. This generalizes recent work on the algebraic structure of nested canalizing functions, and it yields a stratification of all Boolean functions by their canalizing depth. As a result, we obtain closed formulas for the number of n-variable Boolean functions with depth k, which simultaneously generalizes enumeration formulas for canalizing, and nested canalizing functions.

  6. 4. VIEW SHOWING EXCAVATION IN ARIZONA CANAL, 8 MILES NORTHEAST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. VIEW SHOWING EXCAVATION IN ARIZONA CANAL, 8 MILES NORTHEAST OF PHOENIX. NOTE MEN DRILLING AND EXCAVATING IN OPERATION; CAMELBACK MOUNTAIN IN THE DISTANCE Photographer: Walter J. Lubken. No date - Arizona Canal, North of Salt River, Phoenix, Maricopa County, AZ

  7. NORTHERLY STRETCH OF MILLBURY PORTION; GENERAL VIEW ACROSS CANAL PRISM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    NORTHERLY STRETCH OF MILLBURY PORTION; GENERAL VIEW ACROSS CANAL PRISM TO TOWPATH BERM (LATER FILL ENCROACHING LEFT) NEAR CENTER OF THIS STRETCH; VIEW TO SOUTHWEST - Blackstone Canal Worcester-Millbury Segment, Eastern bank of Blackstone River, Millbury, Worcester County, MA

  8. Surgical endodontic management of infected lateral canals of maxillary incisors

    PubMed Central

    2015-01-01

    This case report presents surgical endodontic management outcomes of maxillary incisors that were infected via the lateral canals. Two cases are presented in which endodontically-treated maxillary central incisors had sustained lateral canal infections. A surgical endodontic treatment was performed on both teeth. Flap elevation revealed vertical bone destruction along the root surface and infected lateral canals, and microscopy revealed that the lateral canals were the origin of the lesions. After the infected lateral canals were surgically managed, both teeth were asymptomatic and labial fistulas were resolved. There were no clinical or radiographic signs of surgical endodontic management failure at follow-up visits. This case report highlights the clinical significance and surgical endodontic management of infected lateral canal of maxillary incisor. It is important to be aware of root canal anatomy variability in maxillary incisors. Maxillary central incisors infected via the lateral canal can be successfully managed by surgical endodontic treatment. PMID:25671217

  9. 23. Photocopy of photograph (original print at Gage Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    23. Photocopy of photograph (original print at Gage Canal Company Office), photographer unknown, ca. 1917. VIEW OF FLUME NO. 3 OF GAGE IRRIGATION CANAL AND NEW 66' REINFORCED CONCRETE PIPELINE - California Citrus Heritage Recording Project, Riverside, Riverside County, CA

  10. 24. Photocopy of photograph (original print at Gage Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    24. Photocopy of photograph (original print at Gage Canal Company Office), photographer unknown, ca. 1939. VIEW OF SAND PUMP HOUSE AT THE HEAD OF THE GAGE IRRIGATION CANAL - California Citrus Heritage Recording Project, Riverside, Riverside County, CA

  11. 26. Photocopy of photograph (original print at Gage Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    26. Photocopy of photograph (original print at Gage Canal Company Office), photographer unknown, ca. 1931. VIEW OF CONSTRUCTION OF GUNITE INVERT SIPHON REPLACING FLUME NO. 10 ON GAGE IRRIGATION CANAL - California Citrus Heritage Recording Project, Riverside, Riverside County, CA

  12. 27. Photocopy of photograph (original print at Gage Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    27. Photocopy of photograph (original print at Gage Canal Company Office), photographer unknown, ca. 1913. TIGHTENING JOINTS AND ADJUSTING PLATES ON STEEL FLUME AT MOCKINGBIRD DAM ON THE GAGE IRRIGATION CANAL - California Citrus Heritage Recording Project, Riverside, Riverside County, CA

  13. 22. Photocopy of photograph (original print at Gage Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    22. Photocopy of photograph (original print at Gage Canal Company Office), photographer and date unknown. 'FLUME NO. 9, 'GAGE CANAL SYSTEM,' RIVERSIDE, CAL.' VIEW OF FLUME OVER TEQUESQUITE ARROYO. - California Citrus Heritage Recording Project, Riverside, Riverside County, CA

  14. 29. Photocopy of photograph (original print at Gage Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    29. Photocopy of photograph (original print at Gage Canal Company Office), photographer unknown, ca. 1926. CENTRIFUGAL PUMPS AT OLIVEWOOD PUMPING STATION ON THE GAGE IRRIGATION CANAL - California Citrus Heritage Recording Project, Riverside, Riverside County, CA

  15. 9. VIEW SHOWING ARIZONA CANAL WITH CITRUS ORCHARDS, FACING NORTH. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    9. VIEW SHOWING ARIZONA CANAL WITH CITRUS ORCHARDS, FACING NORTH. CAMELBACK MOUNTAIN IS IN THE BACKGROUND Photographer: unknown. No date - Arizona Canal, North of Salt River, Phoenix, Maricopa County, AZ

  16. 28. Photocopy of photograph (original print at Gage Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    28. Photocopy of photograph (original print at Gage Canal Company Office), photographer unknown, ca. 1913. CONSTRUCTION OF CORE WALL AT MOCKINGBIRD DAM ON THE GAGE IRRIGATION CANAL - California Citrus Heritage Recording Project, Riverside, Riverside County, CA

  17. 2. VIEW NORTHWEST, GENERAL VIEW SHOWING RAILWAY CANAL TRUSS IN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. VIEW NORTHWEST, GENERAL VIEW SHOWING RAILWAY CANAL TRUSS IN CENTER, RAILWAY RIVER TRUSS ON LEFT, HIGHWAY TRUSSES IN BACKGROUND - White Rock Bridge, Spanning Pawcatuck River & White Rock Canal, Westerly, Washington County, RI

  18. 5. VIEW SOUTHWEST, INTERIOR CANAL WALL (Original Fabric) Bald ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. VIEW SOUTHWEST, INTERIOR CANAL WALL (Original Fabric) - Bald Eagle Cross-Cut Canal Lock, North of Water Street along West Branch of Susquehanna River South bank, 500 feet East of Jay Street Bridge, Lock Haven, Clinton County, PA

  19. 7. REMAINS OF PLANK WALL WITHIN CANAL CONSTRUCTED TO PROTECT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. REMAINS OF PLANK WALL WITHIN CANAL CONSTRUCTED TO PROTECT OUTSIDE CANAL BANK, LOOKING SOUTHWEST. NOTE CROSS SUPPORT POLES EXTENDING TO HILLSIDE. - Snake River Ditch, Headgate on north bank of Snake River, Dillon, Summit County, CO

  20. 6. REMAINS OF PLANK WALL NAILED TO POSTS WITHIN CANAL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. REMAINS OF PLANK WALL NAILED TO POSTS WITHIN CANAL CONSTRUCTED TO PROTECT OUTSIDE CANAL BANK. VIEW IS TO THE WEST. - Snake River Ditch, Headgate on north bank of Snake River, Dillon, Summit County, CO

  1. MAIN CANAL HEADWORKS, FROM DOWNSTREAM (TO RIGHT), NOTE SAND AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    MAIN CANAL HEADWORKS, FROM DOWNSTREAM (TO RIGHT), NOTE SAND AND SILT SLUICE GATE FOR DIVERSION DAM ON LEFT, VIEW TO NORTHWEST - Salmon Creek Diversion Dam, Main Canal Headworks, Salmon Creek, Okanogan, Okanogan County, WA

  2. 4. VIEW LOOKING NORTH OF SAN TAN INDIAN CANAL WITH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. VIEW LOOKING NORTH OF SAN TAN INDIAN CANAL WITH NEWER CHECK AND TURNOUT STRUCTURE IN FOREGROUND - San Carlos Irrigation Project, San Tan Indian Canal, North of Gila River, Coolidge, Pinal County, AZ

  3. 12. CONCRETE DROP STRUCTURE ON NORTH SIDE CANAL WITH TWO ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. CONCRETE DROP STRUCTURE ON NORTH SIDE CANAL WITH TWO TURNOUTS IN BACKGROUND, T4S R7E S24. VIEW LOOKING EAST - San Carlos Irrigation Project, North Side Canal, North of Gila River, Coolidge, Pinal County, AZ

  4. 19. VIEW OF SOUTHERN BRANCH OF HIGHLINE CANAL, LOOKING NORTHEAST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    19. VIEW OF SOUTHERN BRANCH OF HIGHLINE CANAL, LOOKING NORTHEAST FROM 56TH STREET, August 1989 - Highline Canal & Pumping Station, South side of Salt River between Tempe, Phoenix & Mesa, Tempe, Maricopa County, AZ

  5. 26. VIEW OF THE PEDESTRIAN BRIDGE CROSSING GRAND CANAL AT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    26. VIEW OF THE PEDESTRIAN BRIDGE CROSSING GRAND CANAL AT 30TH STREET IN PHOENIX, LOOKING WEST, Photographer: Mark Durben, April 1989 - Grand Canal, North side of Salt River, Tempe, Maricopa County, AZ

  6. 21. VIEW OF GRAND CANAL, SHOWING OLD ALIGNMENT, LOOKING WEST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. VIEW OF GRAND CANAL, SHOWING OLD ALIGNMENT, LOOKING WEST LOCATION UNKNOWN. THE WIDE DRY BED OF THE SALT RIVER SPANS THE BACKGROUND. Photographer: Mark Durben, April 1989 - Grand Canal, North side of Salt River, Tempe, Maricopa County, AZ

  7. 10. Tempe Canal, looking south from Apache Boulevard, showing new ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. Tempe Canal, looking south from Apache Boulevard, showing new apartments and old farm silos. Photographer: Mark Durben, February 1989. Source: SRPA - Tempe Canal, South Side Salt River in Tempe, Mesa & Phoenix, Tempe, Maricopa County, AZ

  8. 20. VIEW OF SOUTHERN BRANCH OF HIGHLINE CANAL, LOOKING SOUTHEAST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. VIEW OF SOUTHERN BRANCH OF HIGHLINE CANAL, LOOKING SOUTHEAST FROM 56TH STREET, August 1989 - Highline Canal & Pumping Station, South side of Salt River between Tempe, Phoenix & Mesa, Tempe, Maricopa County, AZ

  9. 6. Tempe Crosscut Canal, looking west from Division Gates. Lateral ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. Tempe Crosscut Canal, looking west from Division Gates. Lateral at left is for local delivery of irrigation water. Photographer: Mark Durben, February 1989. Source: SRPA - Tempe Canal, South Side Salt River in Tempe, Mesa & Phoenix, Tempe, Maricopa County, AZ

  10. 17. VIEW OF SOUTHERN BRANCH OF HIGHLINE CANAL, LOOKING SOUTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    17. VIEW OF SOUTHERN BRANCH OF HIGHLINE CANAL, LOOKING SOUTH FROM GROVE PARKWAY, August 1989 - Highline Canal & Pumping Station, South side of Salt River between Tempe, Phoenix & Mesa, Tempe, Maricopa County, AZ

  11. 18. VIEW OF SOUTHERN BRANCH OF HIGHLINE CANAL, LOOKING SOUTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. VIEW OF SOUTHERN BRANCH OF HIGHLINE CANAL, LOOKING SOUTH TOWARD ELLIOT ROAD, August 1989 - Highline Canal & Pumping Station, South side of Salt River between Tempe, Phoenix & Mesa, Tempe, Maricopa County, AZ

  12. 32. VIEW OF TERMINUS OF GRAND CANAL, SHOWING TURNOUT GATES, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    32. VIEW OF TERMINUS OF GRAND CANAL, SHOWING TURNOUT GATES, LOOKING SOUTHWEST. WASTE WATER IS TURNED INTO THE BED OF NEW RIVER. Photographer: Mark Durben, April 1989 - Grand Canal, North side of Salt River, Tempe, Maricopa County, AZ

  13. 31. VIEW SHOWING DEMOSSING ALONG GRAND CANAL. THE DRAGLINE SCOOPS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    31. VIEW SHOWING DEMOSSING ALONG GRAND CANAL. THE DRAGLINE SCOOPS UP AQUATIC WEEDS AND DEPOSITS THEM IN A DUMP TRUCK. Photographer: Mark Durben, April 1989 - Grand Canal, North side of Salt River, Tempe, Maricopa County, AZ

  14. View north, west (back) wall of canal, mu shed in ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View north, west (back) wall of canal, mu shed in background. - Delaware, Lackawanna & Western Railroad Freight & Rail Yard, Long Slip Canal, New Jersey Transit Hoboken Rail Yard, Hoboken, Hudson County, NJ

  15. 1. LOOKING WEST ON LEHIGH CANAL, GRAPHITE MILL IN FOREGROUND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. LOOKING WEST ON LEHIGH CANAL, GRAPHITE MILL IN FOREGROUND - Pettinos Brothers Graphite Manufacturing Mill, On Sand Island, south side of Lehigh Canal, west of Hill-to-Hill Bridge, Bethlehem, Northampton County, PA

  16. 122. Jet Lowe, Photographer, July 1978. POWER CANAL LOOKING NORTH. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    122. Jet Lowe, Photographer, July 1978. POWER CANAL LOOKING NORTH. WOODEN LINING OF CANAL STILL VISIBLE NEXT TO ROCKS. - Michigan Lake Superior Power Company, Portage Street, Sault Ste. Marie, Chippewa County, MI

  17. Environmental Sampling in the Panama Canal Zone. 1 December 1976.

    DTIC Science & Technology

    1977-01-20

    disappearance of even persistent pesticides may be exceptionally rapid in the tropical climate of the Canal Zone. This report also discusses the nature and scope of pest management operations in the Canal Zone.

  18. Bitter Root Irrigation district canal, looking east, typical section and ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Bitter Root Irrigation district canal, looking east, typical section and crossing - Bitter Root Irrigation Project, Bitter Root Irrigation Canal, Heading at Rock Creek Diversion Dam, West of U.S. Highway 93, Darby, Ravalli County, MT

  19. 58. View of lined canal looking west from road bridge ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    58. View of lined canal looking west from road bridge crossing lined canal. Photo by Brian C. Morris, Puget Power, 1989. - Puget Sound Power & Light Company, White River Hydroelectric Project, 600 North River Avenue, Dieringer, Pierce County, WA

  20. 10. 'Y' CONNECTOR TO PICACHO RESERVOIR ON MAIN CANAL. VIEW ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. 'Y' CONNECTOR TO PICACHO RESERVOIR ON MAIN CANAL. VIEW LOOKING EAST FROM PICACHO RESERVOIR INLET CHANNEL - San Carlos Irrigation Project, Marin Canal, Amhurst-Hayden Dam to Picacho Reservoir, Coolidge, Pinal County, AZ

  1. 2. LOOKING DOWN THE LINED POWER CANAL AS IT WINDS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. LOOKING DOWN THE LINED POWER CANAL AS IT WINDS ITS WAY TOWARD THE CEMENT MILL Photographer: Walter J. Lubken, November 19, 1907 - Roosevelt Power Canal & Diversion Dam, Parallels Salt River, Roosevelt, Gila County, AZ

  2. 7. VIEW OF MAIN CANAL, LOOKING SOUTH, IMMEDIATELY DOWNSTREAM FROM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. VIEW OF MAIN CANAL, LOOKING SOUTH, IMMEDIATELY DOWNSTREAM FROM THE SNAKE RIVER VALLEY IRRIGATION DISTRICT, SECTION 34, T2N, R37E - Woodville Canal Company, West side of Snake River (River Mile 796), Woodville, Bingham County, ID

  3. 12. VIEW OF GAGE IRRIGATION CANAL AT HILLTOP DRIVE AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. VIEW OF GAGE IRRIGATION CANAL AT HILLTOP DRIVE AND BARTON ROAD SHOWING BEGINNING OF SIPHON, DATED '1952' - Gage Irrigation Canal, Running from Santa Ana River to Arlington Heights, Riverside, Riverside County, CA

  4. [Anal abscess with a tuberculous origin: report of two cases and review of the literature].

    PubMed

    Romelaer, Charlotte; Abramowitz, Laurent

    2007-01-01

    Gastrointestinal tuberculosis represents 1% of extrapulmonary tuberculoses and only sporadic cases of anal tuberculosis have been reported in the literature. We report two cases of tuberculous anal abscess and a review of the literature for diagnosis and treatment.

  5. Matters of simulation of the semicircular canal system

    NASA Technical Reports Server (NTRS)

    Gurfinkel, V. S.; Petukhov, S. V.

    1977-01-01

    A scale model of the human semicircular canal system was developed based on the theory of dynamic similitude. This enlarged model makes it convenient to conduct tests on the vestibular processes and dynamics in the semicircular canals. Tests revealed hydromechanical interaction between canals, with asymmetry of the conditions of movement of the endolymph in the canals in opposite directions. A type of vestibular reactions, occurring with angular oscillations of the head, was predicted and demonstrated using this model and human test subjects.

  6. [Radio-anatomical variants of the optic canal].

    PubMed

    Bourjat, P; Bittighoffer, B

    1984-10-01

    Two variants of the optic canal are described by the same patient. During the foetal development, the optic canal and the orbital fissure are first separated by an anterior strut, then by a posterior strut, who secondary fuse into a single optic strut. The keyhole anomaly of the optic canal results from the absence of the posterior optic strut. The duplicate cranial opening of the optic canal results from the absence of fusion of the anterior and posterior struts.

  7. 28. MAIN CANAL Photographic copy of historic photo, July ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    28. MAIN CANAL - Photographic copy of historic photo, July 18, 1906 (original print located at the Carlsbad Irrigation District offices, Carlsbad, New Mexico) J.J. Lubken, photographer 'LOOKING SOUTH FROM STATION 413, ON THE MAIN CANAL, SHOWING THE REMODLING SIC OF THE OLD PECOS VALLEY IRRIGATING CANAL' - Carlsbad Irrigation District, Main Canal, 4 miles North to 12 miles Southeast of Carlsbad, Carlsbad, Eddy County, NM

  8. 14. VIEW OF WESTERN CANAL AT THE SALT RIVER PROJECT'S ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    14. VIEW OF WESTERN CANAL AT THE SALT RIVER PROJECT'S KYRENE STEAM POWER PLANT, TEMPE. THE WESTERN CANAL BEGINS TO TURN NORTH AT THIS POINT, AND DIVERTS WATER TO THE HIGHLINE PUMP PLANT AND THE KYRENE LATERAL. THE KYRENE PLANT INLET (LEFT-CENTER) ALSO DIVERTS CANAL WATER FOR PLANT OPERATION AND COOLING. - Western Canal, South side of Salt River between Tempe, Phoenix & Mesa, Mesa, Maricopa County, AZ

  9. 21. VIEW OF NORTHERN BRANCH OF HIGHLINE CANAL, SECTION 1, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. VIEW OF NORTHERN BRANCH OF HIGHLINE CANAL, SECTION 1, T1S-R3E, SHOWING NON-PROJECT LAND, STILL DESERT, IN FOREGROUND AND CULTIVATED FIELDS OF THE SALT RIVER PROJECT BELOW THE CANAL, LOOKING NORTH. A SMALL PORTION OF NON-IRRIGABLE LAND BELOW THE CANAL IS SHOWN AT LEFT, March 1990 - Highline Canal & Pumping Station, South side of Salt River between Tempe, Phoenix & Mesa, Tempe, Maricopa County, AZ

  10. 13. VIEW OF WESTERN CANAL EAST OF CARRIAGE LANE IN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. VIEW OF WESTERN CANAL EAST OF CARRIAGE LANE IN TEMPE, SHOWING DROP STRUCTURE AND GROUNDWATER PUMP. THIS IS THE LAST OF FOUR PUMPS WHICH FEED DIRECTLY INTO THE CANAL BETWEEN ALMA SCHOOL ROAD AND PRICE ROAD. ON THIS DAY, ALL FOUR PUMPS, OPERATING AT FULL OUTPUT, HAVE CONSIDERABLY SWELLED THE FLOW TO THE CANAL. NOTE THE OLD FASHIONED BRICKWORK ON THE NORTH BANK. - Western Canal, South side of Salt River between Tempe, Phoenix & Mesa, Mesa, Maricopa County, AZ

  11. Experimental reproduction of the papilloma-carcinoma complex of the alimentary canal in cattle.

    PubMed

    Campo, M S; O'Neil, B W; Barron, R J; Jarrett, W F

    1994-08-01

    Bovine papillomavirus type 4 (BPV-4) is the aetiological agent of epithelial papillomas of the upper alimentary canal in cattle. These benign tumours can become a focus for transformation to squamous cell carcinomas in animals feeding on bracken fern. Strong epidemiological evidence suggests that the progression to malignancy is due to the interplay between BPV-4 and mutagenic and immunosuppressing chemicals present in the fern. The carcinomas of the upper alimentary canal are often accompanied by adenomas and adenocarcinomas of the lower intestine and bracken-grazing animals are also heavily immunosuppressed. To elucidate the individual roles and the concerted action of the viral and chemical factors involved in tumorigenesis and malignant conversion, we attempted to reproduce experimentally the cancer syndrome observed in the field. Florid persistent papillomatosis of the upper alimentary canal was reproduced in animals infected with BPV-4 and immunosuppressed either by a diet of bracken or by treatment with azathioprine; cancer of the upper alimentary tract or of the lower intestine developed only in animals infected with virus and fed on bracken fern. As in field cases, BPV-4 DNA was detected in papillomas but not in cancers. We conclude that immunosuppression is necessary for persistence and spread of viral papillomas, that the fern mutagens are responsible for neoplastic conversion of papilloma cells, and that continuous expression of viral functions is not required for the maintenance of the malignant state.

  12. 75 FR 39632 - Regulated Navigation Area; Gulf Intracoastal Waterway, Inner Harbor Navigation Canal, Harvey...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-12

    ..., Inner Harbor Navigation Canal, Harvey Canal, Algiers Canal, New Orleans, LA; Correction ACTION: Interim... Navigation Canal, Harvey Canal, Algiers Canal, New Orleans, LA into the Code of Federal Regulations. That... Commander (LCDR) Marty Daniels, Coast Guard; telephone (504) 565-5044, e-mail...

  13. 155. Photocopy of transit book (taken from Twin Falls Canal ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    155. Photocopy of transit book (taken from Twin Falls Canal Company Surveyor's Transit Book #405T, Page 1, #46 Division One). STATEMENT RE: SURVEY ALIGNMENT 3/03, TWIN FALLS COUNTY, MILNER, IDAHO. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  14. 159. Photocopy of written record (taken from Twin Falls Canal ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    159. Photocopy of written record (taken from Twin Falls Canal Company Low Line Book #1, pp. 76,77). RECORD OF BORROW AT LOW LINE SIPHON. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  15. 156. Photocopy of written record (taken from Twin Falls Canal ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    156. Photocopy of written record (taken from Twin Falls Canal Company, Low Line Book #1, pp.2,3). LOW LINE CONTRACTORS AND BORROW RECORD. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  16. 31. MAIN CANAL Photographic copy of historic photo, December ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    31. MAIN CANAL - Photographic copy of historic photo, December 13, 1939 (original print in '1939 Annual Report of the Carlsbad Project,' located at the Carlsbad Irrigation District offices, Carlsbad, New Mexico) photographer unknown 'LINING MAIN CANAL AROUND GYP BEND' - Carlsbad Irrigation District, Main Canal, 4 miles North to 12 miles Southeast of Carlsbad, Carlsbad, Eddy County, NM

  17. 192. Photocopy of drawing, Twin Falls Canal Company, date unknown. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    192. Photocopy of drawing, Twin Falls Canal Company, date unknown. TOPOGRAPHICAL MAP (DAM DRAWN IN), MILNER SITE, TWIN FALLS COUNTY, MILNER, IDAHO; RIGHT SIDE OF MAP (LEFT ON ID-15-183). - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  18. 183. Photocopy of map (Twin Falls Canal Company). TOPOGRAPHICAL MAP ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    183. Photocopy of map (Twin Falls Canal Company). TOPOGRAPHICAL MAP OF MILNER DAM SITE, TWIN FALLS COUNTY, MILNER, IDAHO; MAP, LEFT SIDE ONLY. CROSS REFERENCE: ID-15-192. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  19. 187. Photocopy of drawing, Twin Falls Canal Company, date unknown. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    187. Photocopy of drawing, Twin Falls Canal Company, date unknown. TOPOGRAPHICAL MAP OF MILNER DAM LOCATION, TWIN FALLS COUNTY, MILNER, IDAHO; BLUEPRINT MAP. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  20. 70. GENERAL VIEW OF CANAL IN DOVER LOOKING EAST. WHAT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    70. GENERAL VIEW OF CANAL IN DOVER LOOKING EAST. WHAT APPEARS TO BE A SWING BRIDGE IS VISIBLE ACROSS CANAL ON RIGHT SIDE OF PHOTOGRAPH (NOTE THAT THIS MAY ALSO BE A LIFT BRIDGE WITH THE LIFT EQUIPMENT REMOVED). - Morris Canal, Phillipsburg, Warren County, NJ

  1. 21 CFR 872.3820 - Root canal filling resin.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Root canal filling resin. 872.3820 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3820 Root canal filling resin. (a) Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate,...

  2. 21 CFR 872.3820 - Root canal filling resin.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Root canal filling resin. 872.3820 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3820 Root canal filling resin. (a) Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate,...

  3. 21 CFR 872.3820 - Root canal filling resin.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Root canal filling resin. 872.3820 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3820 Root canal filling resin. (a) Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate,...

  4. 11. Tempe Canal, looking north from the Superstition Freeway at ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. Tempe Canal, looking north from the Superstition Freeway at the point where the canal turns west toward the Superstition flume. Equipment in center is beginning excavation for the pipe headworks. Photographer: Mark Durben, February 1989. Source: SRPA - Tempe Canal, South Side Salt River in Tempe, Mesa & Phoenix, Tempe, Maricopa County, AZ

  5. 13. Tempe Canal along Price Road, looking north from Baseline ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. Tempe Canal along Price Road, looking north from Baseline Road. This is the section of the canal which will be piped. Photographer: Mark Durben, February 1989. Source: SRPA - Tempe Canal, South Side Salt River in Tempe, Mesa & Phoenix, Tempe, Maricopa County, AZ

  6. 16. VIEW OF HIGHLINE CANAL PIPELINE OUTLET, SHOWING THE OUTLET, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    16. VIEW OF HIGHLINE CANAL PIPELINE OUTLET, SHOWING THE OUTLET, A GROUNDWATER PUMP (LEFT), AND THE SOUTH BRANCH OF THE CANAL (FOREGROUND), August 1989 - Highline Canal & Pumping Station, South side of Salt River between Tempe, Phoenix & Mesa, Tempe, Maricopa County, AZ

  7. 20. VIEW OF GRAND CANAL, SHOWING OLD ALIGNMENT, LOOKING EAST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. VIEW OF GRAND CANAL, SHOWING OLD ALIGNMENT, LOOKING EAST FROM SOUTH BANK NEAR SETTLING BASIN (see HAER Photograph No. AZ-30-17, Crosscut Hydro Plant). THE LARGE FOREGROUND PIPE CARRIED WATER ACROSS THE CANAL FROM THE SETTLING BASIN TO THE CROSSCUT STEAM PLANT. Photographer: Mark Durben, April 1989 - Grand Canal, North side of Salt River, Tempe, Maricopa County, AZ

  8. 82. ROOSEVELT POWER CANAL, SUGGESTED ARRANGEMENT FOR ELECTRICAL OPERATION OF ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    82. ROOSEVELT POWER CANAL, SUGGESTED ARRANGEMENT FOR ELECTRICAL OPERATION OF SLUICE GATES AND CANAL INTAKE GATES AT DIVERSION DAM Courtesy of Dept. of the Interior, Bureau of Reclamation, Salt River Project, Arizona - Roosevelt Power Canal & Diversion Dam, Parallels Salt River, Roosevelt, Gila County, AZ

  9. 14. VIEW OF GAGE IRRIGATION CANAL AT HILLTOP DRIVE AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    14. VIEW OF GAGE IRRIGATION CANAL AT HILLTOP DRIVE AND BARTON ROAD, SHOWING OLD ROUTE OF CANAL VIADUCT ACROSS BARTON ROAD. SIPHON NOW GOES UNDER ROAD AND EMERGES AT RIGHT REAR BELOW TWO TELEPHONE POLES (SEE CA-120-15) - Gage Irrigation Canal, Running from Santa Ana River to Arlington Heights, Riverside, Riverside County, CA

  10. 157. Photocopy of drawing (taken from Twin Falls Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    157. Photocopy of drawing (taken from Twin Falls Canal Company Field Book #360, Page 75, entitled, 'Clay-Seam Cut-Off.' Cross-Reference: ID-15-153). MILNER DAM SURVEY, TWIN FALLS COUNTY, MILNER, IDAHO. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  11. 153. Photocopy of drawing (taken from Twin Falls Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    153. Photocopy of drawing (taken from Twin Falls Canal Company Field Book #360, Page 74, entitled, 'Clay-Seam Cut-Off.' Cross-Reference: ID-15-157). MILNER DAM SURVEY, TWIN FALLS COUNTY, MILNER, IDAHO. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  12. Newer Root Canal Irrigants in Horizon: A Review

    PubMed Central

    Jaju, Sushma; Jaju, Prashant P.

    2011-01-01

    Sodium hypochloride is the most commonly used endodontic irrigant, despite limitations. None of the presently available root canal irrigants satisfy the requirements of ideal root canal irrigant. Newer root canal irrigants are studied for potential replacement of sodium hypochloride. This article reviews the potential irrigants with their advantages and limitations with their future in endodontic irrigation. PMID:22190936

  13. 24. VIEW SHOWING WASTE GATES ON GRAND CANAL AT JUNCTION ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    24. VIEW SHOWING WASTE GATES ON GRAND CANAL AT JUNCTION WITH OLD CROSSCUT NE/4, Sec. 7, TIN, R4E; LOOKING WEST. OLD CROSSCUT CANAL ENTERS FROM RIGHT. WASTE GATE ON LEFT EMPTIES INTO SALT RIVER BED Photographer: Kevin Kreisel-Coons, May 1990 - Grand Canal, North side of Salt River, Tempe, Maricopa County, AZ

  14. 134. FORKS DIVERSION, HIGH LINE AND LOW LINE CANALS, TWIN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    134. FORKS DIVERSION, HIGH LINE AND LOW LINE CANALS, TWIN FALLS COUNTY, SOUTH OF HANSEN, IDAHO; VIEW OF LOW LINE AND POWER GATES, WEST VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  15. 197. Photocopy of drawing, Twin Falls, Canal Company, date unknown. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    197. Photocopy of drawing, Twin Falls, Canal Company, date unknown. GATE STEMS AND LIFTING DEVICES, NO COUNTY; BLUEPRINT SKETCHES. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  16. 132. FORKS DIVERSION, HIGH LINE AND LOW LINE CANALS, TWIN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    132. FORKS DIVERSION, HIGH LINE AND LOW LINE CANALS, TWIN FALLS COUNTY, SOUTH OF HANSEN, IDAHO; POWER GATES FOR HYDRO-ELECTRIC. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID

  17. The treatment of squamous anal carcinoma: guidelines of the Italian Society of Colo-Rectal Surgery.

    PubMed

    Giani, I; Mistrangelo, M; Fucini, C

    2013-04-01

    The Italian society of colo-rectal surgery (SICCR) is dedicated to improving the study, prevention and management of the diseases of the colon, rectum and anus. One of the aims of the society is to establish guidelines to the treatment of these diseases. These guidelines are based on the international literature and on the best available evidence. Clinical practice guidelines are one of the most important instruments to provide therapeutic decision-making support, based on the best scientific evidence available at the time. Guidelines are advisory and not prescriptive, susceptible to continual variations secondary to innovations and new scientific evidence. These guidelines are a guide for all colo-rectal surgeons and physicians who approach anal cancer.

  18. The Panama Canal and Social Justice.

    ERIC Educational Resources Information Center

    Wilde, Margaret D., Ed.

    The booklet, designed to explore the issues of international justice in the context of the Gospel, reviews relations between the United States and Panama. It includes background materials and a study guide for parish leaders and other educators. The central question pertaining to the Panama Canal concerns the rights of the United States according…

  19. 33 CFR 117.1045 - Hood Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... OPERATION REGULATIONS Specific Requirements Washington § 117.1045 Hood Canal. The draw of the Washington State pontoon highway bridge near Port Gamble operates as follows: (a) The draw shall open on signal if at least one hour's notice is given. The draw shall be opened horizontally for 300 feet unless...

  20. Monitoring Project CANAL Training Activities: Parent Day Workshops for 70 Project CANAL Schools (April 18 through July 3, 1991).

    ERIC Educational Resources Information Center

    Davidson, Mary E.; Kurtz, Norman R.

    An evaluation was done to assess the participation of parents from the 70 Creating a New Approach to Learning Project (Project CANAL) schools in Project CANAL training activities. Project CANAL offered workshops for parents during the months of April and July 1991. The parent day workshops were to provide parents of participating schools with data…

  1. Comparison of canal transportation in simulated curved canals prepared with ProTaper Universal and ProTaper Gold systems

    PubMed Central

    Muniz, Brenda Leite; Pires, Frederico; Belladonna, Felipe Gonçalves; Neves, Aline Almeida; Souza, Erick Miranda; De-Deus, Gustavo

    2016-01-01

    Objectives The purpose of this study was to assess the ability of ProTaper Gold (PTG, Dentsply Maillefer) in maintaining the original profile of root canal anatomy. For that, ProTaper Universal (PTU, Dentsply Maillefer) was used as reference techniques for comparison. Materials and Methods Twenty simulated curved canals manufactured in clear resin blocks were randomly assigned to 2 groups (n = 10) according to the system used for canal instrumentation: PTU and PTG groups, upto F2 files (25/0.08). Color stereomicroscopic images from each block were taken exactly at the same position before and after instrumentation. All image processing and data analysis were performed with an open source program (FIJI). Evaluation of canal transportation was obtained for two independent canal regions: straight and curved levels. Student's t test was used with a cut-off for significance set at α = 5%. Results Instrumentation systems significantly influenced canal transportation (p < 0.0001). A significant interaction between instrumentation system and root canal level (p < 0.0001) was found. PTU and PTG systems produced similar canal transportation at the straight part, while PTG system resulted in lower canal transportation than PTU system at the curved part. Canal transportation was higher at the curved canal portion (p < 0.0001). Conclusions PTG system produced overall less canal transportation in the curved portion when compared to PTU system. PMID:26877984

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

    SciTech Connect

    Moureau-Zabotto, Laurence; Ortholan, Cecile; Hannoun-Levi, Jean-Michel; Teissier, Eric; Cowen, Didier; Salem, Nagi; Lemanski, Claire; Ellis, Steve; Resbeut, Michel

    2013-03-01

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

  3. 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

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

    PubMed

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

    2014-06-04

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

  5. Comparison of the rheological properties of four root canal sealers

    PubMed Central

    Chang, Seok Woo; Lee, Young-Kyu; Zhu, Qiang; Shon, Won Jun; Lee, Woo Cheol; Kum, Kee Yeon; Baek, Seung Ho; Lee, In Bog; Lim, Bum-Soon; Bae, Kwang Shik

    2015-01-01

    The flowability of a root canal sealer is clinically important because it improves the penetration of the sealer into the complex root canal system. The purpose of this study was to compare the flowabilities of four root canal sealers, measured using the simple press method (ISO 6876), and their viscosities, measured using a strain-controlled rheometer. A newly developed, calcium phosphate-based root canal sealer (Capseal) and three commercial root canal sealers (AH Plus, Sealapex and Pulp Canal Sealer EWT) were used in this study. The flowabilities of the four root canal sealers were measured using the simple press method (n=5) and their viscosities were measured using a strain-controlled rheometer (n=5). The correlation between these two values was statistically analysed using Spearman's correlation test. The flow diameters and the viscosities of the root canal sealers were strongly negatively correlated (ρ=−0.8618). The viscosity of Pulp Canal Sealer EWT was the lowest and increased in the following order: AH Pluscanal sealers showed characteristic time- and temperature-dependent changes in their rheological properties. The viscosities measured using the strain-controlled rheometer were more precise than the flowabilities measured using the simple press method, suggesting that the rheometer can accurately measure the rheological properties of root canal sealers. PMID:25059248

  6. Dorello's Canal for Laymen: A Lego-Like Presentation

    PubMed Central

    Ezer, Haim; Banerjee, Anirban Deep; Thakur, Jai Deep; Nanda, Anil

    2012-01-01

    Objective Dorello's canal was first described by Gruber in 1859, and later by Dorello. Vail also described the anatomy of Dorello's canal. In the preceding century, Dorello's canal was clinically important, in understanding sixth nerve palsy and nowadays it is mostly important for skull base surgery. The understanding of the three dimensional anatomy, of this canal is very difficult to understand, and there is no simple explanation for its anatomy and its relationship with adjacent structures. We present a simple, Lego-like, presentation of Dorello's canal, in a stepwise manner. Materials and Methods Dorello's canal was dissected in five formalin-fixed cadaver specimens (10 sides). The craniotomy was performed, while preserving the neural and vascular structures associated with the canal. A 3D model was created, to explain the canal's anatomy. Results Using the petrous pyramid, the sixth nerve, the cavernous sinus, the trigeminal ganglion, the petorclival ligament and the posterior clinoid, the three-dimensional structure of Dorello's canal was defined. This simple representation aids in understanding the three dimensional relationship of Dorello's canal to its neighboring structures. Conclusion Dorello's canal with its three dimensional structure and relationship to its neighboring anatomical structures could be reconstructed using a few anatomical building blocks. This method simplifies the understanding of this complex anatomical structure, and could be used for teaching purposes for aspiring neurosurgeons, and anatomy students. PMID:23730547

  7. 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

  8. Managing faecal incontinence or leakage: the Peristeen Anal Plug.

    PubMed

    Doherty, Willie

    Incontinence can be a devastating problem to many individuals. It is embarrassing and limiting socially, and prevents those with the problem from going about their day-to-day activities. People adopt coping strategies to manage the problem and those with urinary incontinence often look for containment products such as disposable pads or nappy-style products. These products have been developed using different absorbent materials and are accessible to sufferers in local supermarkets. Absorbency of the products has improved so that once wetted, they hold urine more easily. However, the same cannot be said for faecal incontinence management products and there are few that can be called upon to manage this devastating condition. The Peristeen Anal Plug, developed originally as the Conveen Anal Plug, stands alone in the search for a device to manage faecal incontinence or leakage.

  9. Population reference range for developmental lumbar spinal canal size

    PubMed Central

    Huang, Junbin; Law, Sheung-Wai; Xiao, Fan; Leung, Jason Chi Shun; Wang, Defeng; Shi, Lin

    2016-01-01

    Background Considerable variability exists in normal developmental lumbar spinal canal size. This impacts the likelihood of neural compromise. Spinal canal development is complete by 17 years. As diseases incurred thereafter do not knowingly affect the developmental size of the spinal canal, it is reasonable to use a selected population undergoing abdominopelvic computed tomography (CT) examination to determine developmental lumbar spinal canal size. Methods Study approval was granted by the Clinical Research Ethics Committee. Between Feb 2014 and Jan 2015, mid-vertebral spinal canal cross-sectional area (CSA), depth, width, and vertebral body CSA at each level from L1–L5 was measured, using a semi-automated computerized method in 1,080 ambulatory patients (540 males, 540 females, mean age, 50.5±17 years). Patient height and weight was measured. Results A reference range for developmental lumbar spinal canal dimensions was developed at each lumbar level for each sex. There was a 34% variation in spinal canal CSA between smallest and largest quartiles. Developmental spinal canal CSA and depth were consistently smallest at L3, enlarging cranially and caudally. Taller people had slightly larger lumbar spinal canals (P<0.0001). Males had larger spinal canal CSAs than females though relative to vertebral body CSA, spinal canal CSA was larger in females. There was no change in spinal canal CSA with age, weight or BMI (P<0.05). Conclusions A population reference range for developmental lumbar spinal canal size was developed. This allows one to objectively determine the degree of developmental spinal canal stenosis present on an individual patient basis. PMID:28090445

  10. Anal human papillomavirus genotype distribution in HIV-infected men who have sex with men by geographical origin, age, and cytological status in a Spanish cohort.

    PubMed

    Torres, Montserrat; González, Cristina; del Romero, Jorge; Viciana, Pompeyo; Ocampo, Antonio; Rodríguez-Fortúnez, Patricia; Masiá, Mar; Blanco, José Ramón; Portilla, Joaquín; Rodríguez, Carmen; Hernández-Novoa, Beatriz; del Amo, Julia; Ortiz, Marta

    2013-11-01

    Knowledge of human papillomavirus (HPV) type distribution in populations at risk for anal cancer is needed. Here, we describe the anal HPV genotype distribution in a large Spanish cohort (Cohort of the Spanish HIV Research Network HPV [CoRIS-HPV]) of HIV-positive men who have sex with men (MSM) according to geographical origin, age, and cytological status. A cross-sectional analysis of baseline data from 1,439 HIV-infected MSM (2007 to 2012) was performed. Anal HPV genotyping was performed using the Linear Array HPV genotyping test. Descriptive analyses of subject characteristics, prevalences, and 95% confidence intervals (CI) were performed. The global prevalences of HPV, high-risk HPV (HR-HPV), and low-risk HPV (LR-HPV) types were 95.8%, 83.0%, and 72.7%, respectively. Among the HR-HPV types, HPV16 was the most common, followed by HPV59, -39, -51, -18, and -52. The prevalence of multiple HR-HPV infections was 58.5%. There were no differences in the crude analyses between Spanish and Latin-American MSM for most HPV types, and a peak in prevalence for most HPV types was seen in patients in their late thirties. Globally and by specific HPV groups, men with abnormal anal cytologies had a higher prevalence of infection than those with normal cytologies. This study has the largest number of HIV-positive MSM with HPV genotype data analyzed according to cytological status as far as we know. The information gained from this study can help with the design of anal cancer prevention strategies in HIV-positive patients.

  11. Anal Human Papillomavirus Genotype Distribution in HIV-Infected Men Who Have Sex with Men by Geographical Origin, Age, and Cytological Status in a Spanish Cohort

    PubMed Central

    Torres, Montserrat; González, Cristina; del Romero, Jorge; Viciana, Pompeyo; Ocampo, Antonio; Rodríguez-Fortúnez, Patricia; Masiá, Mar; Blanco, José Ramón; Portilla, Joaquín; Rodríguez, Carmen; Hernández-Novoa, Beatriz; del Amo, Julia

    2013-01-01

    Knowledge of human papillomavirus (HPV) type distribution in populations at risk for anal cancer is needed. Here, we describe the anal HPV genotype distribution in a large Spanish cohort (Cohort of the Spanish HIV Research Network HPV [CoRIS-HPV]) of HIV-positive men who have sex with men (MSM) according to geographical origin, age, and cytological status. A cross-sectional analysis of baseline data from 1,439 HIV-infected MSM (2007 to 2012) was performed. Anal HPV genotyping was performed using the Linear Array HPV genotyping test. Descriptive analyses of subject characteristics, prevalences, and 95% confidence intervals (CI) were performed. The global prevalences of HPV, high-risk HPV (HR-HPV), and low-risk HPV (LR-HPV) types were 95.8%, 83.0%, and 72.7%, respectively. Among the HR-HPV types, HPV16 was the most common, followed by HPV59, -39, -51, -18, and -52. The prevalence of multiple HR-HPV infections was 58.5%. There were no differences in the crude analyses between Spanish and Latin-American MSM for most HPV types, and a peak in prevalence for most HPV types was seen in patients in their late thirties. Globally and by specific HPV groups, men with abnormal anal cytologies had a higher prevalence of infection than those with normal cytologies. This study has the largest number of HIV-positive MSM with HPV genotype data analyzed according to cytological status as far as we know. The information gained from this study can help with the design of anal cancer prevention strategies in HIV-positive patients. PMID:23966501

  12. Anal sphincter dysfunction in multiple sclerosis: an observation manometric study

    PubMed Central

    Marola, Silvia; Gibin, Enrico; Capobianco, Marco; Bertolotto, Antonio; Enrico, Stefano; Solej, Mario; Martino, Valter; Destefano, Ines; Nano, Mario

    2016-01-01

    Abstract Constipation, obstructed defecation, and fecal incontinence are frequent complaints in multiple sclerosis. The literature on the pathophysiological mechanisms underlying these disorders is scant. Using anorectal manometry, we compared the anorectal function in patients with and without multiple sclerosis. 136 patients referred from our Center for Multiple Sclerosis to the Coloproctology Outpatient Clinic, between January 2005 and December 2011, were enrolled. The patients were divided into four groups: multiple sclerosis patients with constipation (group A); multiple sclerosis patients with fecal incontinence (group B); non-multiple sclerosis patients with constipation (group C); non-multiple sclerosis patients with fecal incontinence (group D). Anorectal manometry was performed to measure: resting anal pressure; maximum squeeze pressure; rectoanal inhibitory reflex; filling pressure and urge pressure. The difference between resting anal pressure before and after maximum squeeze maneuvers was defined as the change in resting anal pressure calculated for each patient. Results Group A patients were noted to have greater sphincter hypotonia at rest and during contraction compared with those in group C (p=0.02); the rectal sensitivity threshold was lower in group B than in group D patients (p=0.02). No voluntary postcontraction sphincter relaxation was observed in either group A or group B patients (p=0.891 and p=0.939, respectively). Conclusions The decrease in the difference in resting anal pressure before and after maximum squeeze maneuvers suggests post-contraction sphincter spasticity, indicating impaired pelvic floor coordination in multiple sclerosis patients. A knowledge of manometric alterations in such patients may be clinically relevant in the selection of patients for appropriate treatments and for planning targeted rehabilitation therapy. PMID:28352843

  13. 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.

  14. 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.

  15. 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.

  16. Water quality of the Boca Raton canal system and effects of the Hillsboro Canal inflow, southeastern Florida, 1990-91

    USGS Publications Warehouse

    McKenzie, D.J.

    1995-01-01

    The City of Boca Raton in southeastern Palm Beach County, Florida, is an urban residential area that has sustained a constant population growth with subsequent increase in water use. The Boca Raton network of canals is controlled to provide for drainage of excess water, to maintain proper coastal ground-water levels to prevent saltwater intrusion, and to recharge the surficial aquifer system from which the city withdraws potable water. Most of the water supplied to the Boca Raton canal system and the surficial aquifer system, other than rainfall and runoff, is pumped from the Hillsboro Canal. The Biscayne aquifer, principal hydrogeologic unit of the surficial aquifer system, is highly permeable and there is a close relation between water levels in the canals and the aquifer. The amount of water supplied by seepage from the conservation areas is unknown. Because the Hillsboro Canal flows from Lake Okeechobee and Water Conservation Areas 1 and 2, which are places of more highly mineralized ground water and surface water, the canal is a possible source of contamination. Water samples were collected at 10 canal sites during wet and dry seasons and analyzed for major inorganic ions and related characteristics, nutrients, and trace elements. All concentrations were generally within or less than the drinking-water standards established by the Florida Department of Environmental Protection. The high concentrations of sodium and chloride that were detected in samples from the Boca Raton canal system are probably from the more mineralized water of the Hillsboro Canal. Other water-quality data, gathered from various sources from 1982 through 1991, did not indicate any significant changes nor trends. The effects of the Hillsboro Canal on the water quality of the Boca Raton canal system are indicated by increased concentrations of sodium, chloride, dissolved solids, and total organic carbon. Concentrations of the constituents in the canal water generally decrease with distance

  17. Congenital narrowing of the cervical spinal canal.

    PubMed Central

    Kessler, J T

    1975-01-01

    The clinical and laboratory findings in six patients with congenital narrowing of the cervical spinal canal and neurological symptoms are described. A variable age of onset and an entirely male occurrence were found. Signs and symptoms of spinal cord dysfunction predominated in all but one patient. Symptoms were produced in five patients by increased physical activity alone. Congenital narrowing of the cervical spinal canal may result in cord compression without a history of injury and occasionally without evidence of significant bony degenerative changes. The clinical features may be distinguishable from those found in cervical spondylosis without congenital narrowing. Intermittent claudication of the cervical spinal cord appears to be an important feature of this syndrome. Surgery improved four out of five people. PMID:1219087

  18. Partial atrioventricular canal defect in a dog.

    PubMed

    Santamarina, G; Espino, L; Vila, M; Suarez, M L

    2002-01-01

    A case of a partial atrial canal defect is described in a nine-month-old female English setter. The patient had a large ostium primum atrial septal defect and a concurrent malformation of the mitral valve. Electrocardiographic and radiographic findings were suggestive of marked enlargement of the right heart and pulmonary overcirculation. Definitive diagnosis and assessment of the haemodynamic consequences were made using echocardiography. The magnitude of the left-to-right intracardiac shunt was estimated by measuring the pulmonary to systemic flow ratio (Qp/Qs) from Doppler-derived pulmonary and aortic blood flow. The results of this report suggest that dogs with a partial atrioventricular canal defect and concurrent mild mitral regurgitation may exhibit no clinical signs during the first years of life, even in cases with a Qp/Qs ratio of greater than 2.

  19. Trimethoxy-resveratrol and piceatannol administered orally suppress and inhibit tumor formation and growth in prostate cancer xenografts

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Resveratrol (Res) is recognized as a promising cancer chemoprevention dietary polyphenol with antioxidative, anti-inflammatory and anticancer properties. However, the role of its analogues in prostate cancer (PCa) chemoprevention is still unknown. METHODS. We synthesized natural and synthetic anal...

  20. Effect of two contemporary root canal sealers on root canal dentin microhardness

    PubMed Central

    2017-01-01

    Background Successful root canal treatment depends on proper cleaning, disinfecting and shaping of the root canal space. Pulpless teeth have lower dentin microhardness value compared to that of vital teeth. A material which can cause change in dentin composition may affect the microhardness. Thus the aim of this study was to evaluate and compare the effect of two root canal sealers on dentin microhardness. Material and Methods Forty two single rooted teeth were selected and divided into 3 equal groups; Apexit, iRootSP and control groups (n=14) Each group was then divided into 2 subgroups according to the post evaluation period; 1 week and 2 months (n=7). Root canal procedure was done in the experimental groups and obturation was made using either; Apexit, iRootSP or left unprepared and unobturated in the control group. Roots were sectioned transversely into cervical, middle and apical segments. The three sections of each root were mounted in a plastic chuck with acrylic resin. The coronal dentin surfaces of the root segments werepolished. Microhardness of each section was measured at 500 µm and 1000 µm from the canal lumen. Results Four way-ANOVA revealed that different tested sealer materials, canal third, measuring distance from the pulp and time as independent variables had statistically non significant effect on mean microhardness values (VHN) at p≤0.001. Among iRootSP groups there was a statistically significant difference between iRoot SP at coronal root portion (87.79±17.83) and iRoot SP at apical root portion (76.26±9.33) groups where (p=0.01). IRoot SP at coronal canal third had higher statistically significant mean microhardness value (87.79±17.83) compared to Apexit at coronal third (73.61±13.47) where (p=0.01). Conclusions Root canal sealers do not affect dentin microhardness. Key words:Root canal, dentin, sealers, microhardness, bioceramic. PMID:28149466

  1. Will the Nicaragua Canal connect or divide?

    PubMed

    Gross, Michael

    2014-11-03

    A century after the opening of the Panama Canal, a second inter-oceanic passage is set to be built in Central America, this time in Nicaragua. The ambitious and astronomically expensive project promises to bring economic opportunity to a poor country but it also carries risks to its tropical ecosystems. Will the new waterway ultimately link two oceans or divide a continent? Michael Gross investigates.

  2. The anomalous canal between two accessory foramina on the mandibular ramus: the temporal crest canal

    PubMed Central

    Han, S-S; Hwang, J-J

    2014-01-01

    Objectives: The temporal crest canal (TCC) is a variation of the bony canal with two accessory foramina that correspond to an entrance and an exit on the mandibular ramus. This study investigated the anatomical characteristics of the TCC using CBCT. Methods: The study population consisted 446 patients who had undergone CBCT. Sagittal, cross-sectional and three-dimensional images were evaluated for the presence of a TCC. The canals were classified into two types according to the configuration, and the location of the posterior accessory foramen of the TCC was also recorded. Results: 6 TCCs were present in 4 of 446 patients (0.90% of the total population). All of the TCCs were observed in males, and all of the posterior foramina were located superior to the mandibular foramina on the medial aspect of the mandibular ramus. There were five noticeably curved and increasingly narrow canals (Type 1) and one slightly curved and uniformly wide canal (Type 2). Conclusions: Precise knowledge of the TCC is clinically important for suitable local anaesthetic nerve block and the planning of surgical procedures that involve the mandibular ramus. Three-dimensional images of CBCT data are particularly effective for confirming the presence of this variation. PMID:24959708

  3. Assessment of long-term quality of life in patients with anal carcinomas treated by radiotherapy with or without chemotherapy

    PubMed Central

    Allal, A S; Sprangers, M A G; Laurencet, F; Reymond, M A; Kurtz, J M

    1999-01-01

    This study was conducted to assess long-term Quality of Life (QOL) in patients treated by radiotherapy with or without chemotherapy for anal carcinomas. Patients with a maximum age of 80 years, and who were alive at least 3 years following completion of treatment with a functioning anal sphincter and without active disease, were selected for this study. Of 52 such patients identified, 41 (79%) were evaluable. There were 35 females and six males with a median age of 71 years (55–80). The median follow-up interval was 116 months (range 37–218). QOL was assessed using two self-rating questionnaires developed by the European Organization for Research and Treatment of Cancer: one for cancer-specific QOL (EORTC QLQ-C30) and one for site-specific QOL (EORTC QLQ-CR38). For the function scales a higher score represents a higher level of functioning (100 being the best score), whereas for the symptom scales a higher score indicates a higher level of symptomatology/problems (0 being the best score). For the QLQ-C30, the functional scale scores ranged from 71 (global quality of life) to 85 (role function) and the symptom scale scores from 6 (nausea-vomiting) to 28 (diarrhoea). For the QLQ-CR38 module the functional scale scores ranged from 13 (sexual functioning) to 74 (body image) and for the symptom scale scores from 5 (weight loss) to 66 (sexual dysfunction in males). None of the functional and symptom scale scores seemed to be better in patients with longer follow-up. In patients treated with sphincter conservation for anal carcinomas, long-term QOL as measured by the EORTC QLQ-C30 and QLQ-CR38 appears to be acceptable, with the exception of diarrhoea and perhaps sexual function. Moreover, the subset of patients who presented with severe complications and/or anal dysfunction showed poorer scores in most scales. © 1999 Cancer Research Campaign PMID:10408404

  4. Controlling anal incontinence in women by performing anal exercises with biofeedback or loperamide (CAPABLe) trial: Design and methods

    PubMed Central

    Jelovsek, J. Eric; Markland, Alayne D.; Whitehead, William E.; Barber, Matthew D.; Newman, Diane K.; Rogers, Rebecca G.; Dyer, Keisha; Visco, Anthony; Sung, Vivian W.; Sutkin, Gary; Meikle, Susan F.; Gantz, Marie G.

    2015-01-01

    The goals of this trial are to determine the efficacy and safety of two treatments for women experiencing fecal incontinence. First, we aim to compare the use of loperamide to placebo and second, to compare the use of anal sphincter exercises with biofeedback to usual care. The primary outcome is the change from baseline in the St. Mark's (Vaizey) Score 24 weeks after treatment initiation. As a Pelvic Floor Disorders Network (PFDN) trial, subjects are enrolling from eight PFDN clinical centers across the United States. A centralized data coordinating center supervises data collection and analysis. These two first-line treatments for fecal incontinence are being investigated simultaneously using a two-by-two randomized factorial design: a medication intervention (loperamide versus placebo) and a pelvic floor strength and sensory training intervention (anal sphincter exercises with manometry-assisted biofeedback versus usual care using an educational pamphlet). Interventionists providing the anal sphincter exercise training with biofeedback have received standardized training and assessment. Symptom severity, diary, standardized anorectal manometry and health-related quality of life outcomes are assessed using validated instruments administered by researchers masked to randomized interventions. Cost effectiveness analyses will be performed using prospectively collected data on care costs and resource utilization. This article describes the rationale and design of this randomized trial, focusing on specific research concepts of interest to researchers in the field of female pelvic floor disorders and all other providers who care for patients with fecal incontinence. PMID:26291917

  5. Molecular network control through boolean canalization.

    PubMed

    Murrugarra, David; Dimitrova, Elena S

    2015-12-01

    Boolean networks are an important class of computational models for molecular interaction networks. Boolean canalization, a type of hierarchical clustering of the inputs of a Boolean function, has been extensively studied in the context of network modeling where each layer of canalization adds a degree of stability in the dynamics of the network. Recently, dynamic network control approaches have been used for the design of new therapeutic interventions and for other applications such as stem cell reprogramming. This work studies the role of canalization in the control of Boolean molecular networks. It provides a method for identifying the potential edges to control in the wiring diagram of a network for avoiding undesirable state transitions. The method is based on identifying appropriate input-output combinations on undesirable transitions that can be modified using the edges in the wiring diagram of the network. Moreover, a method for estimating the number of changed transitions in the state space of the system as a result of an edge deletion in the wiring diagram is presented. The control methods of this paper were applied to a mutated cell-cycle model and to a p53-mdm2 model to identify potential control targets.

  6. Clinicopathological analysis of basal cell carcinoma of the anal region and its distinction from basaloid squamous cell carcinoma.

    PubMed

    Patil, Deepa T; Goldblum, John R; Billings, Steven D

    2013-10-01

    Basal cell carcinoma of the anal region is rare and morphologically difficult to distinguish from basaloid squamous cell carcinoma, particularly on biopsies. This distinction has therapeutic and prognostic implications. We reviewed morphological features of 9 basal cell carcinomas and 15 basaloid squamous cell carcinomas from the anal region diagnosed during 1993-2011 and determined the utility of Ber-EP4, BCL2, TP63, CK5/6, CDKN2A, and SOX2 as diagnostic tools. Immunostains were scored in a semi-quantitative manner (1+-1-10%, 2+-11-50%, 3+->50%). All basal cell carcinomas were located in the perianal region, while all basaloid squamous cell carcinomas originated in the anal canal/anorectum. Nodular subtype of basal cell carcinoma was the most common subtype. Retraction artifact was the only significant distinguishing histological feature of basal cell carcinoma compared with basaloid squamous cell carcinoma (88% vs 26%; P=0.04). Atypical mitoses were more common in basaloid squamous cell carcinomas (71% vs 11%; P=0.05). An in situ component was only present in basaloid squamous cell carcinomas, and was noted in 6/15 cases. Basal cell carcinomas had 2-3+ Ber-EP4 (basal cell carcinoma 100% vs basaloid squamous cell carcinoma 40%; P<0.001) and BCL2 immunoreactivity (basal cell carcinomas 100% vs basaloid squamous cell carcinoma 33%; P<0.001). Diffuse CDKN2A and SOX2 expression was seen only in basaloid squamous cell carcinomas (basal cell carcinoma 0% vs basaloid squamous cell carcinoma 93%; P<0.001). There was no difference in TP63 and CK5/6 expression. Perianal location, retraction artifact, and lack of atypical mitoses are histological features that help distinguish basal cell carcinoma from basaloid squamous cell carcinoma. An in situ component, when present, supports the diagnosis of basaloid squamous cell carcinoma. Immunostains are extremely helpful as diffuse Ber-EP4 and BCL2 expression is a feature of basal cell carcinoma and basaloid squamous cell carcinoma

  7. A new engine-driven canal preparation system with electronic canal measuring capability.

    PubMed

    Kobayashi, C; Yoshioka, T; Suda, H

    1997-12-01

    A new cordless engine-driven root canal preparation system has been developed that electronically monitors the location of the file tip and the torque applied to the file during all instrumentation procedures. The Root ZX is mounted inside the handpiece to measure the canal length. The engine is driven with a rechargeable battery, and it works more than 40 minutes without a recharge. Nickel-titanium files are used for this preparation system. The file is rotated at 240 to 280 rpms. When the file tip reaches the apical constriction, the revolution of the file can be automatically reversed (Auto-apical-reverse mechanism). If there is too much torque, the rotation is automatically reversed (Auto-torque-reverse mechanism). These automatic functions promise a safer engine preparation of the canal with nickel-titanium files.

  8. Involved-Field, Low-Dose Chemoradiotherapy for Early-Stage Anal Carcinoma

    SciTech Connect

    Hatfield, Paul; Cooper, Rachel; Sebag-Montefiore, David

    2008-02-01

    Purpose: To report the results of patients with early-stage anal cancer treated using a low-dose, reduced-volume, involved-field chemoradiotherapy protocol. Methods and Materials: Between June 2000 and June 2006, 21 patients were treated with external beam radiotherapy (30 Gy in 15 fractions within 3 weeks) and concurrent chemotherapy (bolus mitomycin-C 12 mg/m{sup 2} on Day 1 to a maximum of 20 mg followed by infusion 5-fluorouracil 1,000 mg/m{sup 2}/24 h on Days 1-4). Of the 21 patients, 18 underwent small-volume, involved-field radiotherapy and 3 were treated with anteroposterior-posteroanterior parallel-opposed pelvic fields. Of the 21 patients, 17 had had lesions that were excised with close (<1 mm) or involved margins, 1 had had microinvasive disease on biopsy, and 3 had had macroscopic tumor <2 cm in diameter (T1). All were considered to have Stage N0 disease radiologically. Results: After a median follow-up of 42 months, only 1 patient (4.7%) had experienced local recurrence and has remained disease free after local excision. No distant recurrences or deaths occurred. Only 1 patient could not complete treatment (because of Grade 3 gastrointestinal toxicity). Grade 3-4 hematologic toxicity occurred in only 2 patients (9.5%). No significant late toxicity was identified. Conclusion: The results of our study have shown that for patients with anal carcinoma who have residual microscopic or very-small-volume disease, a policy of low-dose, reduced-volume, involved-field chemoradiotherapy produces excellent local control and disease-free survival, with low rates of acute and late toxicity.

  9. Cancer

    MedlinePlus

    Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms ... be benign or malignant. Benign tumors aren't cancer while malignant ones are. Cells from malignant tumors ...

  10. Environmental pollution and shipping feasibility of the Nicaragua Canal.

    PubMed

    Chen, Jihong; Zeng, Xin; Deng, Yibing

    2016-12-15

    In recent years, the Nicaraguan government's renewed interest in constructing this interoceanic canal has once again aroused widespread concern, particularly in the global shipping industry. The project's immense ecological risks, coupled with the recent expansions of both the Panama Canal and the Suez Canal, have raised questions among scientists and experts about its viability. Whether the Nicaragua Canal is really feasible for international shipping, given its high marine pollution risks, requires the further study. This paper discusses and analyses the feasibility of the Nicaragua Canal in the context of its environmental impact and value as a shipping service. This paper aims to provide an important information reference to inform strategic decision-making among policymakers and stakeholders. Our research results indicate that the environmental complexity, economic costs and safety risks of building a new transoceanic canal are simply too high to justify the project.

  11. 9. EAST SIDE CANAL Photographic copy of historic photo, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    9. EAST SIDE CANAL - Photographic copy of historic photo, September 17, 1940 (original print in '1940 Annual Report of the Carlsbad Project,' located at the Carlsbad Irrigation District offices, Carlsbad, New Mexico) photographer unknown 'CCC ENROLLEES STARTING EXCAVATION FOR ROCK LINING DOWNSTREAM FROM STA. 22. EAST CANAL, LAT. #8' - Carlsbad Irrigation District, East Side Canal, 1 mile North to 2 miles East of Carlsbad, Carlsbad, Eddy County, NM

  12. 10. EAST SIDE CANAL Photographic copy of historic photo, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. EAST SIDE CANAL - Photographic copy of historic photo, December 3, 1940 (original print in '1940 Annual Report of the Carlsbad Project,' located at the Carlsbad Irrigation District offices, Carlsbad, New Mexico) photographer unknown 'LOOKING DOWN FROM STA. #22 LATERAL #8, EAST CANAL. AFTER CCC ENROLLEES FINISHED ROCK LINING' - Carlsbad Irrigation District, East Side Canal, 1 mile North to 2 miles East of Carlsbad, Carlsbad, Eddy County, NM

  13. PLANS AND SECTIONS. WEIR SPILLWAY. TEXAS HILL CANAL STA. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    PLANS AND SECTIONS. WEIR SPILLWAY. TEXAS HILL CANAL - STA. 132+82.15. TEXAS HILL CANAL AND DISTRIBUTION SYSTEM. United States Department of Interior, Bureau of Reclamation; Gila Project, Arizona, Wellton-Mohawk Division. Drawing No. 50-D-3200, dated February 7, 1955, Denver, Colorado - Wellton-Mohawk Irrigation System, Relift Station, Texas Hill Canal 2.5, Northern Terminus of Avenue 51 East, approximately .5 mile south of Union Pacific Railroad, Wellton, Yuma County, AZ

  14. GENERAL PLANS AND SECTIONS. WASTEWAY NO. 1. WELLTONMOHAWK CANAL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    GENERAL PLANS AND SECTIONS. WASTEWAY NO. 1. WELLTON-MOHAWK CANAL - STA. 99+23.50. United States Department of the Interior, Bureau of Reclamation; Gila Project, Arizona, Wellton-Mohawk Division. Drawing No. 50-D-2422, dated January 19, 1949, Denver Colorado - Wellton-Mohawk Irrigation System, Wasteway No. 1, Wellton-Mohawk Canal, North side of Wellton-Mohawk Canal, bounded by Gila River to North & the Union Pacific Railroad & Gila Mountains to south, Wellton, Yuma County, AZ

  15. A new approach to canal surface with parallel transport frame

    NASA Astrophysics Data System (ADS)

    Kiṣi, Ilim; Öztürk, Günay

    In the present study, we attend to the canal surfaces with the spine curve γ according to the parallel transport frame in Euclidean 4-space 𝔼4. We give an example of these surfaces and obtain some results about curvature conditions in 𝔼4. Moreover, the visualizations of projections of canal surfaces are presented. Lastly, we give the necessary and sufficient conditions for canal surfaces to become weak superconformal.

  16. Magnetic resonance imaging of the internal auditory canal

    SciTech Connect

    Daniels, D.L.; Herfkins, R.; Koehler, P.R.; Millen, S.J.; Shaffer, K.A.; Williams, A.L.; Haughton, V.M.

    1984-04-01

    Three patients with exclusively or predominantly intracanalicular neuromas and 5 with presumably normal internal auditory canals were examined with prototype 1.4- or 1.5-tesla magnetic resonance (MR) scanners. MR images showed the 7th and 8th cranial nerves in the internal auditory canal. The intracanalicular neuromas had larger diameter and slightly greater signal strength than the nerves. Early results suggest that minimal enlargement of the nerves can be detected even in the internal auditory canal.

  17. 82. CANAL WEST OF LOCK 12 EAST NEAR BOONTON. STORAGE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    82. CANAL WEST OF LOCK 12 EAST NEAR BOONTON. STORAGE BUILDING AND CHUTE ON LEFT SIDE OF CANAL MAY BE A COAL FACILITY. COAL WOULD BE UNLOADED FROM THE BOAT AND PASSED UP THE CHUTE INTO THE COAL STORAGE BIN. COAL COULD THEN BE LOADED INTO WAGONS FROM THE BOTTOM OF THE BIN ON THE OPPOSITE SIDE OF THE STRUCTURE WHEN NECESSARY. - Morris Canal, Phillipsburg, Warren County, NJ

  18. Recurrent anal fistulae: Limited surgery supported by stem cells

    PubMed Central

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

    2015-01-01

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

  19. Computer simulation and capacity evaluation of Panama Canal alternatives

    SciTech Connect

    Rosselli, A.T.; Bronzini, M.S.; Weekly, D.A.

    1994-12-31

    The Operating Characteristics and Capacity Evaluation (OCCE) Study was one of the components of a group of studies of future alternatives to the Panama Canal, sponsored by a study commission formed by the governments of Panama, the US and Japan. The basic tool in the conduct of the study was the Waterway Analysis Model (WAM), developed originally by the US Army Corps of Engineers for use on the US inland waterway system and adapted under OCCE for study of Panama Canal alternatives. The study synthesized the many alternative plans for the Canal proposed historically into four basic groups: High-Rise Lock Canal, Low-Rise Lock Canal, Sea-Level Canal and Status Quo Canal. For economy, the sea-level cases were based on, essentially, a single-lane canal, in conjunction with the status quo canal. Hydraulic and navigation studies indicted that to achieve safe navigation, tide gates or locks would be required to control currents that would otherwise be generated by the differences in tides between the two oceans. The alternatives studied in detail are illustrated in the body of the paper.

  20. 12. VIEW OF WESTERN CANAL AT ALMA SCHOOL ROAD IN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. VIEW OF WESTERN CANAL AT ALMA SCHOOL ROAD IN MESA, THE LOCATION AT WHICH THE PECK, PINE AND WALLACE FEEDERS FORMERLY JOINED TO FORM THE WESTERN CANAL. THE PECK AND PINE FEEDERS, NOW KNOWN AS LATERAL 9 AND LATERAL 10, AND ALMOST ENTIRELY PIPED, STILL JOIN THE WESTERN CANAL AT THIS POINT, BUT AN EQUALLY IMPORTANT SOURCE OF SUPPLY IS THE NUMEROUS GROUNDWATER PUMPS LOCATED ON THE SYSTEM. - Western Canal, South side of Salt River between Tempe, Phoenix & Mesa, Mesa, Maricopa County, AZ

  1. Inverse solution of ear-canal area function from reflectance.

    PubMed

    Rasetshwane, Daniel M; Neely, Stephen T

    2011-12-01

    A number of acoustical applications require the transformation of acoustical quantities, such as impedance and pressure that are measured at the entrance of the ear canal, to quantities at the eardrum. This transformation often requires knowledge of the shape of the ear canal. Previous attempts to measure ear-canal area functions were either invasive, non-reproducible, or could only measure the area function up to a point mid-way along the canal. A method to determine the area function of the ear canal from measurements of acoustic impedance at the entrance of the ear canal is described. The method is based on a solution to the inverse problem in which measurements of impedance are used to calculate reflectance, which is then used to determine the area function of the canal. The mean ear-canal area function determined using this method is similar to mean ear-canal area functions measured by other researchers using different techniques. The advantage of the proposed method over previous methods is that it is non- invasive, fast, and reproducible.

  2. GeoGebra helps to know canal surfaces better

    NASA Astrophysics Data System (ADS)

    Bímová, Daniela; Bittnerová, Daniela; Vraštil, Ondřej

    2015-11-01

    GeoGebra 5.0 is the dynamic geometric and mathematic software which dynamic tools allow the user to solve dynamic problems in a plane and as well as in the three-dimensional space. The contribution presents the dynamic applets constructed in GeoGebra 5.0 that show the origin as well as some properties of various kinds of canal surfaces. There are described the applets for constructing the canal surfaces in the paper. Some of the created canal surfaces are compared with the real life canal surface examples.

  3. 21. 1934 aerial of Tempe Canal, Sections 19 and 30 ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. 1934 aerial of Tempe Canal, Sections 19 and 30 (T1N R5E) and Sections 24 and 25 (T1N R4E) (top of page is north). The main canal enters the picture at upper right and curves out of picture at lower right. The Hayden Branch (thin dark line) runs from top of picture to the southwest, then curves to the west. The Western Branch enters picture running parallel to main canal, then angles off to southwest. Photographer: Unknown, 1934. Source: SRP Cartographic Drafting - Tempe Canal, South Side Salt River in Tempe, Mesa & Phoenix, Tempe, Maricopa County, AZ

  4. MAXILLARY FIRST PREMOLAR WITH THREE ROOT CANALS: A CASE REPORT

    PubMed Central

    Sulaiman, A.O; Dosumu, O.O; Amedari, McKing

    2013-01-01

    The maxillary first premolar is the most commonly bi- rooted tooth with occasional presentation of three roots system; it is a transitional tooth between incisors and molars. Although it usually has two canals, it may rarely have three and this third canal can easily be missed. Thus meticulous knowledge of tooth morphology, careful interpretation of angled radiographs, proper access cavity preparation and a detailed exploration of the interior of the tooth is needed to ensure a proper endodontic treatment. This article reports a rare finding of three canals in a maxillary first premolar with non well defined root outline radiographically during an elective root canal treatment. PMID:25161429

  5. Unexpected Anal Squamous Cells Carcinoma after Open Hemorrhoidectomy

    PubMed Central

    Luca, Navarra; Valentina, Abruzzese; Federico, Sista; Renato, Pietroletti

    2015-01-01

    We report a case of unexpected anal squamous cells carcinoma found in hemorrhoidectomy specimen. The patient had a 3-year history of prolapsing hemorrhoids. A prolapsing hemorrhoid was present at eleven o'clock in lithotomy. Milligan-Morgan was performed and gross examination of the specimen was unremarkable. Histopathologic evaluation showed noninvasive squamous cells carcinoma. The present case report evidences the opportunity of routine histopathologic analysis of hemorrhoidal specimens particularly in case of long-standing prolapse. Questions arise in the option of those techniques where no specimens are collected or tissue is excised far from deceased area. PMID:25922781

  6. Amoebic anal fistula: new insight into an old disease.

    PubMed

    Agrawal, Vivek; Garg, Pankaj Kumar; Jain, Bhupendra Kumar; Mishra, Kiran; Mohanty, Debajyoti

    2014-04-01

    A 67-year-old gentleman underwent fistulectomy for low trans-sphincteric anal fistula along with curettage for an associated abscess extending proximally for half a centimeter into the intersphincteric plane. The roof of the cavity became clearly visible after satisfactory culmination of the surgical procedure. Histopathological examination of the fistulous tract and the curetted granulation tissue revealed presence of multiple trophozoites of Entamoeba histolytica exhibiting erythrophagocytosis in the background of mixed inflammatory infiltrate. This case report provides the outlook that yields the novel insight into the possible role of Entamoeba histolytica in the pathogenesis and persistence of the fistulous tract.

  7. A rare case of myeloid sarcoma presenting as anal fissure

    PubMed Central

    VECCHIO, R.; INTAGLIATA, E.; FIUMARA, P.F.; VILLARI, L.; MARCHESE, S.; CACCIOLA, E.

    2015-01-01

    Myeloid sarcoma is a tumor composed of myeloblasts occurring at an extramedullary site. It may develop in patients with acute myeloid leukemia, myeloproliferative or myelodysplastic syndrome, sometimes preceding onset of the systemic disease. Frequent sites of myeloid sarcoma are bones or various soft tissues. Gastrointestinal involvement is very rare. We report a unique case of myeloid sarcoma presenting as a painful anal fissure, in a patient with a history of acute myeloid leukemia. The diagnosis was achieved by a surgical excisional biopsy and immunoistochemical staining. PMID:26712260

  8. Assessment of trace metal contamination in a historical freshwater canal (Buckingham Canal), Chennai, India.

    PubMed

    Jayaprakash, M; Nagarajan, R; Velmurugan, P M; Sathiyamoorthy, J; Krishnamurthy, R R; Urban, B

    2012-12-01

    The present study was done to assess the sources and the major processes controlling the trace metal distribution in sediments of Buckingham Canal. Based on the observed geochemical variations, the sediments are grouped as South Buckingham Canal and North Buckingham Canal sediments (SBC and NBC, respectively). SBC sediments show enrichment in Fe, Ti, Mn, Cr, V, Mo, and As concentrations, while NBC sediments show enrichment in Sn, Cu, Pb, Zn, Ni, and Hg. The calculated Chemical Index of Alteration and Chemical Index of Weathering values for all the sediments are relatively higher than the North American Shale Composite and Upper Continental Crust but similar to Post-Archaean Average Shale, and suggest a source area with moderate weathering. Overall, SBC sediments are highly enriched in Mo, Zn, Cu, and Hg (geoaccumulation index (I(geo)) class 4-6), whereas NBC sediments are enriched in Sn, Cu, Zn, and Hg (I(geo) class 4-6). Cu, Ni, and Cr show higher than Effects-Range Median values and hence the biological adverse effect of these metals is 20%; Zn, which accounts for 50%, in the NBC sediments, has a more biological adverse effect than other metals found in these sediments. The calculated I(geo), Enrichment Factor, and Contamination Factor values indicate that Mo, Hg, Sn, Cu, and Zn are highly enriched in the Buckingham Canal sediments, suggesting the rapid urban and industrial development of Chennai Metropolitan City have negatively influenced on the surrounding aquatic ecosystem.

  9. Canalers and Conservationists: The Projected Cross-Florida Canal. Instructional Activities Series IA/S-8.

    ERIC Educational Resources Information Center

    Fernald, Edward A.

    This activity is one of a series of 17 teacher-developed instructional activities for geography at the secondary-grade level described in SO 009 140. This activity investigates environmental quality employing the problem-solving technique. Using a map which shows the proposed route of the cross-Florida barge canal as a focal point, the teacher…

  10. [Choice of surgical procedure and management of postoperative incision for anal fistula].

    PubMed

    Chen, Chaowen; Peng, Bo

    2015-12-01

    Anal fistula is a common disease in general surgery. It is difficult to heal without intervention and surgical treatment is the major treatment. Method of surgical treatment and management of postoperative incision are based on features and classifications of anal fistula. Choosing the appropriate approach in accordance with specific conditions of patients can obtain effective healing and proper protection against anal sphincter, along with the improvement of life quality. Comprehensive evaluation on methods of surgical treatment and managements of postoperative incision for anal fistula is presented in this paper.

  11. Large small cell carcinoma of anorectal canal.

    PubMed

    Ghahramani, Leila; Mohammadianpanah, Mohammad; Hosseini, Seyed Vahid; Hosseinzade, Masood; Izadpanah, Ahmad; Ebrahimian, Saba; Bananzadeh, Alimohammad

    2014-03-01

    Neurofibromatosis type-1 (NF1), also known as Von Recklinghausen disease, is an autosomal dominant disorder with incidence of one per 4000. Neurofibromas are benign, heterogeneous, peripheral nerve sheath tumors coming up from the connective tissue of peripheral nerve sheaths, particularly the endoneurium. Visceral involvement in disseminated neurofibromatosis is considered rare. Neurofibroma occurs most frequently in the stomach and jejunum, but colon and anorectal canal may also be involved. Gastrointestinal neurofibromas may lead to bleeding, obstruction, intussusception, protein-losing enteropathy and bowel perforation. We encountered a case of diffusely involving the anorectal area by huge neurofibroma, which resulted in pelvic pain with watery diarrhea and urgency.

  12. [Frey's syndrome of the external auditory canal].

    PubMed

    Constantinidis, J; Kyriafinis, G; Ereliadis, S; Daniilidis, J

    2004-10-01

    Frey's syndrome of the external auditory canal is extremely rare. A 55-year old woman presented with a 6 month history of unilateral gustatory otorrhea. She never complained of hearing impairment, tinnitus, vertigo or otalgia. No trauma or surgical signs were evident near the ear or parotid gland. Examination of the ear showed an intact tympanic membrane without disease. A diagnosis of gustatory sweating syndrome was suggested by the observation of sweat production after chewing and by Minor's starch-iodine test. Symptoms were relieved after tympanic neurectomy. The pathogenesis, differential diagnosis and treatment options are discussed.

  13. Suez Canal Clearance Operation, Task Force 65

    DTIC Science & Technology

    1975-05-01

    and remove the four wrecks from the central region of the canal; DREDGE 23, Tug MONGUED, Dredge KASSER and a Concrete Caisson. All salvage operations...feet BUCKET DREDGE NO. 23 72.00 1600 tons 191 feet TUG MONGUED 81.50 1200 tons 165 feet DIPPER DREDGE KASSER 81.50 1200 tons 125 feet CONCRETE CAISSON...MONGUED, DREDGE KASSER , and DREDGE 23 to wet dump in the Great Bitter Lake. Heavy crane THOR arrived in Port Said after transit from Hamburg, Germany

  14. Efficacy of a bivalent HPV 16/18 vaccine against anal HPV16/18 infection among young women: a nested analysis within the Costa Rica Vaccine Trial

    PubMed Central

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

    2011-01-01

    Background Anal cancer remains rare (incidence of ∼1.5 per 100,000 women annually) but rates are increasing in many countries. Human papillomavirus-16 (HPV16) infection causes most cases. We evaluated vaccine efficacy (VE) of an ASO4-adjuvanted HPV16/18 vaccine against anal HPV16/18 infection. Methods In a randomized double-blind controlled trial designed to evaluate VE against persistent cervical HPV16/18 infections and associated precancerous lesions in Costa Rica, 4210 healthy women underwent anal specimen collection (4224 of 5968= 70.8% of eligible women) at the final blinded study visit 4 years after vaccination to evaluate anal HPV16/18 VE. Cervical HPV16/18 VE among the same women at the same visit was calculated as a comparator. For this ancillary work, analyses were conducted in a restricted cohort of women both cervical HPV16/18 DNA negative and HPV 16/18 seronegative prior at enrollment (N=1989), and in the full cohort (all women with an anal specimen). Findings In the restricted cohort, VE against prevalent HPV16/18 anal infection measured one-time, four-years post-vaccination was 83.6% (95%CI 66.7% to 92.8%), which was comparable to cervical HPV16/18 VE (87.9%, 95%CI 77.4% to 94.0%). In the full cohort, HPV16/18 VE was statistically lower at the anus (62.0%, 95%CI 47.1% to 73.1%) compared to the cervix (76.4%, 95%CI 67.0% to 83.5%) (p for anatomic-site interaction =0.03). Significant and comparable VE estimates against a composite endpoint of HPV31/33/45 (i.e.: cross-protection) was observed at the anus and cervix. Interpretation The ASO4-adjuvanted vaccine affords strong protection against anal HPV, particularly among women more likely to be HPV naïve at vaccination. Funding. The Costa Rica HPV Vaccine Trial is sponsored and funded by the NCI (contract N01-CP-11005), with funding support from the National Institutes of Health Office of Research on Women's Health, and conducted with support from the Ministry of Health of Costa Rica. Vaccine was

  15. Water Environment Evolution along the China Grand Canal

    NASA Astrophysics Data System (ADS)

    Mao, F.; Wu, Y. X.; Yang, B. F.; Li, X. J.

    2014-03-01

    The China Grand Canal is one of the earliest canals in the world, having lasted for nearly 3000 years. Even its section canals have a rich history, such as the North-South Grand Canal that was established during the Sui Dynasty, whereas the Beijing-Hangzhou Canal was excavated during the Yuan Dynasty and the east line of the South-to-North Water Diversion. As one of the longest in the world, the China Grand Canal's total length is over 3500 kilometers. This length includes the navigable, unnavigable, and underground sections. Making the best use of situations and according to local conditions, the Chinese people harmoniously constructed the Beijing-Hangzhou Canal with nature. Tens of millions of workers took nearly 3000 years to complete the great shipping system. Navigable sections still exist for up to 900 kilometers and the volume of freight traffic is approximately 300 million tons. The canal remains the main logistical channel of the North-to-South Coal Transportation, South-to-North Water Diversion, and resources circulation. To date, China is promoting the success of heritage application. Part of these efforts is the declaration of the China Grand Canal as a World Cultural Heritage by 2014. In addition, the east route of the South-to-North Water Transfer project is planned to be navigable by 2016. The ancient Beijing-Hangzhou Grand Canal will usher in the new ecological civilization and cultural revival along the canal. This paper presents technical methods of water environment evolution research on the river system, river, and water quality along the Beijing-Hangzhou Canal through the integration of historical literature and modern remote sensing image data. The study carried out water environment investigation and analysis along the Beijing-Hangzhou canal by using ETM, SPOT image data, and GPS measurement data. Spatial and temporal evolution characteristics and regulations of the Beijing-Hangzhou Grand Canal regional water environment in the span of 3000

  16. Root canal filling evaluation using optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Negrutiu, Meda L.; Sinescu, Cosmin; Topala, Florin; Nica, Luminita; Ionita, Ciprian; Marcauteanu, Corina; Goguta, Luciana; Bradu, Adrian; Dobre, George; Rominu, Mihai; Podoleanu, Adrian Gh.

    2010-04-01

    Endodontic therapy consists in cleaning and shaping the root canal system, removing organic debris and sealing the intra-canal space with permanent filling materials. The purpose of this study was to evaluate various root canal fillings in order to detect material defects, the marginal adaptation at the root canal walls and to assess the quality of the apical sealing. 21 extracted single-root canal human teeth were selected for this study. We instrumented all roots using NiTi rotary instruments. All canals were enlarged with a 6% taper size 30 GT instrument, 0,5 mm from the anatomical apex. The root canals were irrigated with 5% sodium hypochlorite, followed by 17% ethylenediaminetetraacetic acid (EDTA). After the instrumentation was completed, the root canals were obturated using a thermoplasticizable polymer of polyesters. In order to assess the defects inside the filling material and the marginal fit to the root canal walls, the conebeam micro-computed tomography (CBμCT) was used first. After the CBμCT investigation, time domain optical coherence tomography working in en face mode (TDefOCT) was employed to evaluate the previous samples. The TDefOCT system was working at 1300 nm and was doubled by a confocal channel at 970 nm. The results obtained by CBμCT revealed no visible defects inside the root-canal fillings and at the interfaces with the root-canal walls. TDefOCT investigations permit to visualize a more complex stratificated structure at the interface filling material/dental hard tissue and in the apical region.

  17. 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.

  18. Retrospective measures on applying endoscopic YAG laser to treat alimentary canal diseases from 1983 to 1995

    NASA Astrophysics Data System (ADS)

    Wang, Rui-Zhong; Wu, Ning-Xiao; Gao, Su-ping; Rong, Zeng-Qin

    1996-05-01

    It was in 1983 when we started to apply YAG laser to do experiments on animal and fresh internal organs off the body to confirm its effectiveness. Then we started to use it in clinical practice. Up to October 1995, in the twelve years, we treated 1075 cases, 2574 person times. Seven-hundred-seventy-nine cases of various esophagostenosis. Four-hundred-fifty-six of them were malignant stenosis, 295 anastomostenosis, 15 stenosis after radiotherapeutics, 7 corrosive anastomostenosis, 6 inflammatory anastomostenosis, plus we cured 5 cardia losses of relax, and 241 polyps in the alimentary canal. Among the 2154 polyps cured, 6 were that of esophagus, 6 that of cardia, 25 that of stomach, 10 that of duodenum, 194 that of large intestine. In addition, we treated 15 alimentary canal bleeding and 35 malignant colon and tectum cancers. Our experience in laser operating on the coelom has become richer and richer. The methods we used are being widened. The range of our laser application is being enlarged. We have gained our own experience in preventing complications and keeping the endoscopy from being damaged. The cure rate of the non-malignant had raised up to 98.7%. Cure rate of the malignant had raised up to 91%. The alimentary canal polyps can be cured perfectly. It is hard to tell whether YAG laser or high frequency electroresection has the advantage over the other. Besides, this paper is going to put forward several questions to discuss.

  19. Monitoring of phenolic compounds and surfactants in water of Ganga Canal, Haridwar (India)

    NASA Astrophysics Data System (ADS)

    Seth, Richa; Singh, Prashant; Mohan, Manindra; Singh, Rakesh; Aswal, Ravinder Singh

    2013-12-01

    The Ganga Canal emerging out from Ganga River has great ritual importance among pilgrims and tourists at Haridwar, Uttarakhand, India. The Canal is being polluted due to mass bathing, washing, disposal of sewage, industrial waste and these human activities are deteriorating its water quality. To determine the impact of these activities, Ganga Canal water quality at five sites between Haridwar and Roorkee namely Pantdweep, Har Ki Pauri, Singhdwar, Piran Kaliyar and Old Bridge, Roorkee has been analyzed for organic pollutants phenolic compounds and surfactants, which have rarely been assessed and reported so far. The results of analysis show that phenolic compounds are not present in water samples of selected five sites during bi-monthly monitoring from January 2012 to November 2012. The Har Ki Pauri, Singhdwar, Piran Kaliyar and Old Bridge, Roorkee sites have been detected with surfactant concentrations (1.18, 1.63, 3.2 and 2.5 mg/l) more than permissible limit (1.00 mg/l). Also at most of the sites, surfactants' concentration crossed the desirable limit of BIS during the period of analysis. This distribution of surfactants in water has potential risk for skin diseases and cancer and requires regular monitoring with appropriate measures.

  20. Update on Schlemm's Canal Based Procedures

    PubMed Central

    Mansouri, Kaweh; Shaarawy, Tarek

    2015-01-01

    Surgical options for glaucoma have expanded in recent years. This article provides an evidence-based update on the novel or emerging surgical techniques for the treatment of open-angle glaucoma that are based on the Schlemm's canal (SC). Canaloplasty is an ab externo approach and was developed as an alternative to traditional filtering surgeries. The Hydrus microstent (Ivantis Inc., Irvine, CA) is a so-called SC scaffold that directly bypasses the trabecular meshwork to drain aqueous humor into the SC, which it keeps dilated over approximately one quadrant. Canaloplasty has also been shown to lower intraocular pressure (IOP) by up to 40% and combined with cataract surgery. IOP was lowered 44% at 24 months while maintaining a favorable safety profile. The Hydrus device has been proposed as an adjunct to cataract extraction surgery. To date, no published evidence from clinical trials is available on its in vivo safety and efficacy. Schlemm's canal based glaucoma procedures show promise as alternative treatments to traditional glaucoma surgery. Surgeons must be comfortable with angle anatomy. A prerequisite for functionality of these techniques is the integrity of the distal outflow system. At present, however, it is not possible to conclude whether these novel procedures will be viable alternatives to standard filtering surgery over the long-term. PMID:25624672

  1. New Technologies to Improve Root Canal Disinfection.

    PubMed

    Plotino, Gianluca; Cortese, Teresa; Grande, Nicola M; Leonardi, Denise P; Di Giorgio, Gianni; Testarelli, Luca; Gambarini, Gianluca

    2016-01-01

    Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.

  2. 33 CFR 117.273 - Canaveral Barge Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Canaveral Barge Canal. 117.273 Section 117.273 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Florida § 117.273 Canaveral Barge Canal. (a) The drawspan of the Christa McAuliffe...

  3. 33 CFR 117.159 - Grant Line Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Grant Line Canal. 117.159 Section 117.159 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements California § 117.159 Grant Line Canal. The draw of the San Joaquin County highway bridge, mile 5.5...

  4. 33 CFR 117.235 - Chesapeake and Delaware Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Chesapeake and Delaware Canal. 117.235 Section 117.235 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Delaware § 117.235 Chesapeake and Delaware Canal. The draw of the Conrail bridge, mile...

  5. 33 CFR 117.239 - Lewes and Rehoboth Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Lewes and Rehoboth Canal. 117.239 Section 117.239 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Delaware § 117.239 Lewes and Rehoboth Canal. (a) The draw of the Savannah Road/SR 18...

  6. 33 CFR 117.586 - Annisquam River and Blynman Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Annisquam River and Blynman Canal. 117.586 Section 117.586 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Massachusetts § 117.586 Annisquam River and Blynman Canal. The draw of the Blynman...

  7. 33 CFR 117.181 - Oakland Inner Harbor Tidal Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Oakland Inner Harbor Tidal Canal. 117.181 Section 117.181 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements California § 117.181 Oakland Inner Harbor Tidal Canal. The draws of the...

  8. 33 CFR 117.769 - Black Rock Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Black Rock Canal. 117.769 Section 117.769 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements New York § 117.769 Black Rock Canal. The draws of...

  9. 33 CFR 117.589 - Cape Cod Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Cape Cod Canal. 117.589 Section 117.589 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Massachusetts § 117.589 Cape Cod Canal. The draw...

  10. 33 CFR 117.589 - Cape Cod Canal.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Cape Cod Canal. 117.589 Section 117.589 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Massachusetts § 117.589 Cape Cod Canal. The draw...

  11. 33 CFR 117.589 - Cape Cod Canal.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Cape Cod Canal. 117.589 Section 117.589 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Massachusetts § 117.589 Cape Cod Canal. The draw...

  12. 33 CFR 117.589 - Cape Cod Canal.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Cape Cod Canal. 117.589 Section 117.589 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Massachusetts § 117.589 Cape Cod Canal. The draw...

  13. 33 CFR 117.589 - Cape Cod Canal.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Cape Cod Canal. 117.589 Section 117.589 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Massachusetts § 117.589 Cape Cod Canal. The draw...

  14. Photocopy of photograph (from Barge Canal contract 56, photo album ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph (from Barge Canal contract 56, photo album negative, 49, New York State Archives and Manuscripts), photographer unknown, 1912 View northwest, barge canal sluice around 5 combined, completed - Glens Falls Feeder, Sluice, Along south side of Glens Falls Feeder between locks 10 & 20, Hudson Falls, Washington County, NY

  15. Photocopy of photograph (from Barge Canal contract 56, photo album ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph (from Barge Canal contract 56, photo album negative 26, New York State Archives and Manuscripts), photographer unknown, 1912 View northwest, barge canal sluice around 5 combined under construction - Glens Falls Feeder, Sluice, Along south side of Glens Falls Feeder between locks 10 & 20, Hudson Falls, Washington County, NY

  16. 29. VIEW OF GRAND CANAL, LOOKING WEST TOWARD BROPHY PREP ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    29. VIEW OF GRAND CANAL, LOOKING WEST TOWARD BROPHY PREP AND ST. FRANCIS CHURCH (compare this photograph with AZ-17-15, taken at the same spot in 1937). Photographer: Kevin Kreisel-Coons, May 1990 - Grand Canal, North side of Salt River, Tempe, Maricopa County, AZ

  17. 3. GENERAL VIEW ACROSS CANAL PRISM TO TOWPATH BERM NORTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. GENERAL VIEW ACROSS CANAL PRISM TO TOWPATH BERM NORTH OF THE SPILLWAY; VIEW TO WEST FROM ROUTE 146 EMBANKMENT. - Blackstone Canal Millbury Segment, Beginning northwest of State Route 146 & McCracken Road, running along west side of Route 146, Millbury, Worcester County, MA

  18. 1. GENERAL VIEW, TOWPATH BERM (CENTER) AND CANAL PRISM (LEFT) ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. GENERAL VIEW, TOWPATH BERM (CENTER) AND CANAL PRISM (LEFT) SOUTH OF THE SPILLWAY; VIEW TO SOUTH. - Blackstone Canal Millbury Segment, Beginning northwest of State Route 146 & McCracken Road, running along west side of Route 146, Millbury, Worcester County, MA

  19. 2. GENERAL VIEW ACROSS CANAL PRISM TO TOWPATH BERM SOUTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. GENERAL VIEW ACROSS CANAL PRISM TO TOWPATH BERM SOUTH OF THE SPILLWAY; VIEW TO SOUTHWEST FROM ROUTE 146 EMBANKMENT. - Blackstone Canal Millbury Segment, Beginning northwest of State Route 146 & McCracken Road, running along west side of Route 146, Millbury, Worcester County, MA

  20. REACTIVITY MEASUREMENT FACILITY, UNDER CONSTRUCTION OVER MTR CANAL IN BASEMENT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    REACTIVITY MEASUREMENT FACILITY, UNDER CONSTRUCTION OVER MTR CANAL IN BASEMENT OF MTR BUILDING, TRA-603. WOOD PLANKS REST ON CANAL WALL OBSERVABLE IN FOREGROUND. INL NEGATIVE NO. 11745. Unknown Photographer, 8/20/1954 - Idaho National Engineering Laboratory, Test Reactor Area, Materials & Engineering Test Reactors, Scoville, Butte County, ID

  1. 25. Photocopy of photograph (original print at Gage Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    25. Photocopy of photograph (original print at Gage Canal Company Office), photographer unknown, March 1954. VIEW OF THE GAGE IRRIGATION CANAL, CONCRETE 'COVERING COMPLETED & BACKFILLED TO WATERMAN AVENUE...CURVING TOWARD NO. 1 TUNNEL' - California Citrus Heritage Recording Project, Riverside, Riverside County, CA

  2. Convergence or reticulation? Mosaic evolution in the canalized American Amaryllidaceae

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Canalization is defined as the suppression of phenotypic variation, or, in the context of molecular evolution, genetic buffering that has evolved under natural selection in order to stabilize the phenotype. Very little is understood on the processes behind canalization, even in today’s genomic era....

  3. 1. General oblique view from south side of Canal Street ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. General oblique view from south side of Canal Street showing Paper Machine Building at southwest corner of site; view to northeast. - Champion-International Paper Company, Paper Machine Building, West bank of Spicket River at Canal Street, Lawrence, Essex County, MA

  4. 3. VIEW EAST, DETAIL OF INTERIOR CANAL WALL (Original Fabric) ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. VIEW EAST, DETAIL OF INTERIOR CANAL WALL (Original Fabric) - Bald Eagle Cross-Cut Canal Lock, North of Water Street along West Branch of Susquehanna River South bank, 500 feet East of Jay Street Bridge, Lock Haven, Clinton County, PA

  5. 6. VIEW WEST, INTERIOR CANAL WALL, FLOOR FULLY EXCAVATED (Original ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. VIEW WEST, INTERIOR CANAL WALL, FLOOR FULLY EXCAVATED (Original Fabric) - Bald Eagle Cross-Cut Canal Lock, North of Water Street along West Branch of Susquehanna River South bank, 500 feet East of Jay Street Bridge, Lock Haven, Clinton County, PA

  6. 7. SAND FILTERS, CANAL TO LEFT. CONCRETE OVERFLOW AREA TO ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. SAND FILTERS, CANAL TO LEFT. CONCRETE OVERFLOW AREA TO LEFT OF CANAL ORIGINALLY PLANNED AS A STORAGE LAKE. VIEW LOOKING DUE WEST OF HINDS COMPLEX IN BACKGROUND OF SAND FILTERS. - Hinds Pump Plant, East of Joshua Tree National Monument, 5 miles north of Route 10, Hayfield, Riverside County, CA

  7. 78 FR 10524 - Drawbridge Operation Regulation; Charenton Canal, Baldwin, LA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-14

    ... (BNSF) Railway Company swing span bridge across Charenton Canal, mile 0.4, at Baldwin, St. Mary Parish... temporary deviation from the operating schedule of the swing span railroad bridge across the Charenton Canal... the passage of vessels. This deviation allows the swing span of the bridge to remain in the...

  8. 5 CFR 550.714 - Panama Canal Commission employees.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Panama Canal Commission employees. 550... PAY ADMINISTRATION (GENERAL) Severance Pay § 550.714 Panama Canal Commission employees. (a) Notwithstanding any other provisions of this subpart, an employee separated from employment with the Panama...

  9. 5 CFR 550.714 - Panama Canal Commission employees.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Panama Canal Commission employees. 550... PAY ADMINISTRATION (GENERAL) Severance Pay § 550.714 Panama Canal Commission employees. (a) Notwithstanding any other provisions of this subpart, an employee separated from employment with the Panama...

  10. 5 CFR 550.714 - Panama Canal Commission employees.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Panama Canal Commission employees. 550... PAY ADMINISTRATION (GENERAL) Severance Pay § 550.714 Panama Canal Commission employees. (a) Notwithstanding any other provisions of this subpart, an employee separated from employment with the Panama...

  11. 5 CFR 550.714 - Panama Canal Commission employees.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Panama Canal Commission employees. 550... PAY ADMINISTRATION (GENERAL) Severance Pay § 550.714 Panama Canal Commission employees. (a) Notwithstanding any other provisions of this subpart, an employee separated from employment with the Panama...

  12. 5 CFR 550.714 - Panama Canal Commission employees.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Panama Canal Commission employees. 550... PAY ADMINISTRATION (GENERAL) Severance Pay § 550.714 Panama Canal Commission employees. (a) Notwithstanding any other provisions of this subpart, an employee separated from employment with the Panama...

  13. 8. FLUME BOX Y, LOOKING NORTH. CANAL HEADING RIGHT FOLLOWS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. FLUME BOX Y, LOOKING NORTH. CANAL HEADING RIGHT FOLLOWS HILLSIDE INTO DRAINAGE; FLUME HEADING LEFT CROSSED GULCH ON A TRESTLE. NOTE CONCRETE ABUTMENTS NEAR TOP RIGHT INSTALLED IN 1935 TO PREVENT WATER FROM ESCAPING CANAL AT OLD TRESTLE ENTRANCE. - Snake River Ditch, Headgate on north bank of Snake River, Dillon, Summit County, CO

  14. 14. ANGULAR QUARTZITE ROCK REINFORCEMENT ON INTERIOR OF OUTSIDE CANAL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    14. ANGULAR QUARTZITE ROCK REINFORCEMENT ON INTERIOR OF OUTSIDE CANAL BANK, LOOKING SOUTH-SOUTHEAST. CANAL ROUTE VISIBLE ALONG HILLSIDE NEAR TOP LEFT. NOTE DILLON RESERVOIR, HIGHWAY 6, AND NEW RESIDENTIAL CONSTRUCTION AT RIGHT AND CENTER. - Snake River Ditch, Headgate on north bank of Snake River, Dillon, Summit County, CO

  15. 10. CANAL CUT THROUGH SHALE BEDROCK ON PROMINENT POINT, LOOKING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. CANAL CUT THROUGH SHALE BEDROCK ON PROMINENT POINT, LOOKING NORTH-NORTHEAST. NOTE CONCRETE ABUTMENTS PROBABLY INSTALLED IN 1935 TO PREVENT WATER FROM ESCAPING THROUGH A CANAL BANK BREACH. - Snake River Ditch, Headgate on north bank of Snake River, Dillon, Summit County, CO

  16. 5. Lower end of the Old Crosscut Canal, circa 1977 ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. Lower end of the Old Crosscut Canal, circa 1977 aerial view. The Old Crosscut runs from bottom right to join the Grand. Note lack of trees, and wasteway to the bed of the Salt River. Photographer unknown. Source: Pueblo Grande Museum Cultural Park. - Old Crosscut Canal, North Side of Salt River, Phoenix, Maricopa County, AZ

  17. 22. VIEW OF GRAND CANAL, SHOWING OLD ALIGNMENT, LOOKING WEST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    22. VIEW OF GRAND CANAL, SHOWING OLD ALIGNMENT, LOOKING WEST FROM BELOW THE SETTLING BASIN (see HAER Photograph No. AZ-30-17, Crosscut Hydro Plant). Photographer: Mark Durben, April 1989 - Grand Canal, North side of Salt River, Tempe, Maricopa County, AZ

  18. 18. VIEW OF GRAND CANAL, SHOWING OLD ALIGNMENT BEFORE 1989 ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. VIEW OF GRAND CANAL, SHOWING OLD ALIGNMENT BEFORE 1989 REALIGNMENT, LOOKING NORTH TOWARD RAILROAD CROSSING AND CROSSCUT STEAM PLANT LARGE WHITE BUILDING. THE CROSSCUT HYDRO PLANT IS HIDDEN BY TREES TO RIGHT OF STEAM PLANT. Photographer: Mark Durben, April 1989 - Grand Canal, North side of Salt River, Tempe, Maricopa County, AZ

  19. 63. CANAL BOAT IN CRADLE AT TOP OF PLANE. TO ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    63. CANAL BOAT IN CRADLE AT TOP OF PLANE. TO PASS OVER THE SUMMIT (THE HUMP OF LAND AT THE TOP OF PLANE TO HOLD BACK THE WATER AT THAT LEVEL), THE BOATS HAVE SEEN HINGED AND TWO CRADLES ARE USED TO CARRY THE BOAT UP THE PLANE. - Morris Canal, Phillipsburg, Warren County, NJ

  20. 33 CFR 117.769 - Black Rock Canal.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Black Rock Canal. 117.769 Section 117.769 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements New York § 117.769 Black Rock Canal. The draws of...

  1. 33 CFR 117.769 - Black Rock Canal.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Black Rock Canal. 117.769 Section 117.769 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements New York § 117.769 Black Rock Canal. The draws of...

  2. 33 CFR 117.769 - Black Rock Canal.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Black Rock Canal. 117.769 Section 117.769 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements New York § 117.769 Black Rock Canal. The draws of...

  3. 33 CFR 117.769 - Black Rock Canal.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Black Rock Canal. 117.769 Section 117.769 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements New York § 117.769 Black Rock Canal. The draws of...

  4. 33 CFR 117.159 - Grant Line Canal.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Grant Line Canal. 117.159 Section 117.159 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements California § 117.159 Grant Line Canal. The draw of...

  5. Locomotor head movements and semicircular canal morphology in primates

    PubMed Central

    Malinzak, Michael D.; Kay, Richard F.; Hullar, Timothy E.

    2012-01-01

    Animal locomotion causes head rotations, which are detected by the semicircular canals of the inner ear. Morphologic features of the canals influence rotational sensitivity, and so it is hypothesized that locomotion and canal morphology are functionally related. Most prior research has compared subjective assessments of animal “agility” with a single determinant of rotational sensitivity: the mean canal radius of curvature (R). In fact, the paired variables of R and body mass are correlated with agility and have been used to infer locomotion in extinct species. To refine models of canal functional morphology and to improve locomotor inferences for extinct species, we compare 3D vector measurements of head rotation during locomotion with 3D vector measures of canal sensitivity. Contrary to the predictions of conventional models that are based upon R, we find that axes of rapid head rotation are not aligned with axes of either high or low sensitivity. Instead, animals with fast head rotations have similar sensitivities in all directions, which they achieve by orienting the three canals of each ear orthogonally (i.e., along planes at 90° angles to one another). The extent to which the canal configuration approaches orthogonality is correlated with rotational head speed independent of body mass and phylogeny, whereas R is not. PMID:23045679

  6. C-shaped root canal configuration: A review of literature

    PubMed Central

    Fernandes, Marina; de Ataide, Ida; Wagle, Rahul

    2014-01-01

    The aim is to review and discuss the etiology, incidence, anatomic features, classification, diagnosis and management of the C-shaped canal configuration. C-shaped canal configuration is a variation that has a racial predilection and is commonly seen in mandibular second molars. The intricacies present in this variation of canal morphology can pose a challenge to the clinician during negotiation, debridement and obturation. Manual and electronic searches of literature were performed from 1979 to 2012, in Pub Med by crossing the keywords: C-shaped canals, mandibular second molar, mandibular first premolar, root canal morphology. Knowledge of the C-shaped canal configuration is essential to achieve success in endodontic therapy. Radiographic and clinical diagnoses can aid in identification and negotiation of the fan-shaped areas and intricacies of the C-shaped anatomy. Effective management of this anomalous canal configuration can be achieved with rotary and hand instrumentation assisted with sonics and ultrasonics. Modifications in the obturation techniques will ensure a 3-dimensional fill of the canal system and chamber retained restorations like amalgam or composites, serve as satisfactory post endodontic restorations. PMID:25125841

  7. Context view, looking northeast along the Wellton Canal and access ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Context view, looking northeast along the Wellton Canal and access road at the Radial Gate Check. Antelope Hill is visible in the background - Wellton-Mohawk Irrigation System, Radial Gate Check with Drop, Wellton Canal 9.9, West of Avenue 34 East & north of County Ninth Street, Wellton, Yuma County, AZ

  8. 33 CFR 117.495 - Superior Oil Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Superior Oil Canal. 117.495 Section 117.495 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.495 Superior Oil Canal. The draw...

  9. 33 CFR 117.495 - Superior Oil Canal.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Superior Oil Canal. 117.495 Section 117.495 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.495 Superior Oil Canal. The draw...

  10. 36. MAIN CANAL Photographic copy of construction drawing dated ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    36. MAIN CANAL - Photographic copy of construction drawing dated 1907 (from Record Group 115, Box 17, Denver Branch of the National Archives, Denver) WASTE GATES ABOVE DARK CANYON SIPHON - Carlsbad Irrigation District, Main Canal, 4 miles North to 12 miles Southeast of Carlsbad, Carlsbad, Eddy County, NM

  11. HISTORIC PHOTOGRAPH SHOWING DREDGING OF THE FLOOD CONTROL CANAL. Report ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    HISTORIC PHOTOGRAPH SHOWING DREDGING OF THE FLOOD CONTROL CANAL. Report to the Governor, Territory of Hawaii, by the Superintendent of Public Works, Year ending June 30, 1938. - Waikele Canal Bridge and Highway Overpass, Farrington Highway and Waikele Stream, Waipahu, Honolulu County, HI

  12. 1. Drop Structure on the Arizona Crosscut Canal. Photographer unknown, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. Drop Structure on the Arizona Crosscut Canal. Photographer unknown, no date. Note that caption is incorrect: in relation to Camelback Mountain (rear), this can only be the Old Crosscut. Source: reprinted from the 13th Annual Report of the U.S. Geological Survey, 1893. - Old Crosscut Canal, North Side of Salt River, Phoenix, Maricopa County, AZ

  13. 33 CFR 117.495 - Superior Oil Canal.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Superior Oil Canal. 117.495 Section 117.495 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.495 Superior Oil Canal. The draw...

  14. 33 CFR 117.495 - Superior Oil Canal.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Superior Oil Canal. 117.495 Section 117.495 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.495 Superior Oil Canal. The draw...

  15. 33 CFR 117.495 - Superior Oil Canal.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Superior Oil Canal. 117.495 Section 117.495 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Louisiana § 117.495 Superior Oil Canal. The draw...

  16. 62. VIEW SHOWING END OF THE ARIZONA CANAL AT SKUNK ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    62. VIEW SHOWING END OF THE ARIZONA CANAL AT SKUNK CREEK, LOOKING WEST. DEMOSSING STATION IS LEFT OF CENTER AND DRAIN GATES ARE RIGHT OF CENTER Photographer: James Eastwood, July 1990 - Arizona Canal, North of Salt River, Phoenix, Maricopa County, AZ

  17. 57. View of road bridge crossing lined canal from south ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    57. View of road bridge crossing lined canal from south side of lined canal, looking northeast. Photo by Brian C. Morris, Puget Power, 1989. - Puget Sound Power & Light Company, White River Hydroelectric Project, 600 North River Avenue, Dieringer, Pierce County, WA

  18. 33 CFR 117.653 - St. Mary's Falls Canal.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false St. Mary's Falls Canal. 117.653 Section 117.653 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS Specific Requirements Michigan § 117.653 St. Mary's Falls Canal. The draw...

  19. 20. Photocopied August 1978. CANAL SECTION III, LOOKING SOUTH, AUGUST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. Photocopied August 1978. CANAL SECTION III, LOOKING SOUTH, AUGUST OR SEPTEMBER 1900, FOLLOWING A MAJOR BANK SLIDE. SLIDES LIKE THIS ONE WERE FAIRLY FREQUENT FOLLOWING RAIN STORMS BEFORE THE CANAL WALLS WERE TIMBER LINED IN THE EARTH SECTIONS. (64) - Michigan Lake Superior Power Company, Portage Street, Sault Ste. Marie, Chippewa County, MI

  20. 21. Photocopy of photograph (original print at Gage Canal Company ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. Photocopy of photograph (original print at Gage Canal Company Office), H. B. Wesner, photographer, date unknown. 'VIEWS OF SOUTHERN CALIFORNIA SCENERY. ARTESIAN WELLS, SAN BERNARDINO, CALIFORNIA. SUPPLYING THE GAGE CANAL OF RIVERSIDE.' - California Citrus Heritage Recording Project, Riverside, Riverside County, CA