Science.gov

Sample records for chronic anal fissure

  1. Transperineal sonographic anal sphincter complex evaluation in chronic anal fissures.

    PubMed

    Bedair, Elsaid M; El Hennawy, Hany M; Moustafa, Ahmed Abdu; Meki, Gad Youssef; Bosat, Bosat Elwany

    2014-11-01

    The purpose of this study was to assess the role of transperineal sonography in assessment of pathologic changes to the anal sphincter complex in patients with chronic anal fissures. We conducted a prospective case-control study of 100 consecutive patients of any age and both sexes with chronic anal fissures who presented to a colorectal clinic between January 2012 and August 2013 (group A) and 50 healthy volunteers (group B). The most common patterns of radiologic changes to anal sphincters associated with chronic anal fissures were circumferential thickening of the anal sphincter complex in 5 patients (5%), circumferential thickening of the internal anal sphincter in 3 patients (3%), preferential thickening of the internal anal sphincter at the 6-o'clock position in 80 patients (80%) and the 12-o'clock position in 7 patients (7%), preferential thickening of the internal and external anal sphincters in 3 patients (3%), and thinning of the internal anal sphincter in 2 patients (2%). Chronic anal fissures cause differential thickening of both internal and external anal sphincters, with a trend toward increased thickness in relation to the site of the fissure. Routine preoperative transperineal sonography for patients with chronic anal fissures is recommended, and it is mandatory in high-risk patients. © 2014 by the American Institute of Ultrasound in Medicine.

  2. [Botulinum toxin and chronic anal fissure].

    PubMed

    Daniel, Fady; de Parades, Vincent; Siproudhis, Laurent; Atienza, Patrick

    2006-05-01

    Lateral internal sphincterotomy is widely used in the treatment of chronic anal fissure. However, it is associated with a high rate of irreversible incontinence. For this reason the botulinum toxin has become a medical means of reversible sphincterotomy. Indeed, this neurotoxin induces relaxation of the smooth internal anal sphincter lasting one to three months after one injection. We reviewed the published studies about the use of this technique in the management of chronic anal fissure. Healing occurred in more than 70% of fissures without irreversible incontinence. Although further studies are needed to determine the best modalities of administration, especially due to the remaining significant recurrence rate, this toxin may be a valuable treatment for chronic anal fissure in the future.

  3. Anal fissure.

    PubMed

    Schlichtemeier, Steven; Engel, Alexander

    2016-02-01

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

  4. Anal fissure

    PubMed Central

    Schlichtemeier, Steven; Engel, Alexander

    2016-01-01

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

  5. Anal Fissure

    PubMed Central

    Zaghiyan, Karen N.; Fleshner, Phillip

    2011-01-01

    Anal fissure is one of the most common anorectal problems. Anal fissure is largely associated with high anal sphincter pressures and most treatment options are based on reducing anal pressures. Conservative management, using increased fiber and warm baths, results in healing of approximately half of all anal fissures. In fissures that fail conservative care, various pharmacologic and surgical options offer satisfactory cure rates. Lateral internal sphincterotomy remains the gold standard for definitive management of anal fissure. This review outlines the key points in the presentation, pathophysiology, and management of anal fissure. PMID:22379402

  6. 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

  7. Anal Fissure.

    PubMed

    Beaty, Jennifer Sam; Shashidharan, M

    2016-03-01

    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.

  8. Gonyautoxin: new treatment for healing acute and chronic anal fissures.

    PubMed

    Garrido, Rogelio; Lagos, Nestor; Lattes, Karinna; Abedrapo, Mario; Bocic, Gunther; Cuneo, Aldo; Chiong, Hector; Jensen, Christian; Azolas, Rodrigo; Henriquez, Ana; Garcia, Carlos

    2005-02-01

    The mayor symptoms of chronic anal fissure are permanent pain, intense pain during defecation that lasts for hours, blood in the stools, and sphincter cramps. It is subsequent to formation of fibrosis infiltrate that leads to an increased anal tone with poor healing tendency. This vicious circle leads to fissure recurrence and chronicity. This study was designed to show the efficacy of gonyautoxin infiltration in healing patients with anal fissures. Gonyautoxin is a paralyzing phytotoxin produced by dinoflagellates. Fifty recruited patients received clinical examination, including proctoscopy and questionnaire to evaluate the symptoms. Anorectal manometries were performed before and after toxin injection. Doses of 100 units of gonyautoxin in a volume of 1 ml were infiltrated into both sides of the anal fissure in the internal anal sphincter. Total remission of acute and chronic anal fissures were achieved within 15 and 28 days respectively. Ninety-eight percent of the patients healed before 28 days with a mean time healing of 17.6 +/- 9 days. Only one relapsed during 14 months of follow-up. Neither fecal incontinence nor other side effects were observed. All patients showed immediate sphincter relaxation. The maximum anal resting pressures recorded after two minutes decreased to 56.2 +/- 12.5 percent of baseline. Gonyautoxin breaks the vicious circle of pain and spasm that leads to anal fissure. This study proposes gonyautoxin anal sphincter infiltration as safe and effective alternative therapeutic approach to conservative, surgical, and botulinum toxin therapies for anal fissures.

  9. A study of suppurative pathologies associated with chronic anal fissures.

    PubMed

    Gupta, P J

    2005-07-01

    Suppurative pathologies associated with chronic anal fissures are common but not well documented. Fissure abscess, post-fissure fistula, and post-fissure antibioma are but a few of them. These pathologies increase the complications and morbidity of the primary lesion and need a comprehensive approach. From the hospital case record of 532 patients treated for chronic anal fissures, 88 patients (16.5%) were found to have one of these pathologies. This retrospective study describes such pathologies in terms of demographics, clinical presentation, pathological features, operative technique and outcome. Of the 88 patients who presented with pain and discharge per anus, 90% could resume their duties within a week of the surgical procedure. Wound healing took between 2 weeks and 2 months. At the last follow- up at 18 months, three patients had a recurrence (3.4%). Suppuration in chronic anal fissure seems to be more frequent than described. While dealing with the anal fissure, it is desirable to look for and attend to these associated pathologies, especially to avoid complications and morbidity of the primary disease.

  10. Modern perspectives in the treatment of chronic anal fissures.

    PubMed

    Bhardwaj, R; Parker, M C

    2007-07-01

    Anal fissures are commonly encountered in routine colorectal practice. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. Simple measures are often effective for early fissures. Glyceryl trinitrate is well established as a first-line pharmacological therapy. The roles of diltiazem and botulinum, particularly as rescue therapy, are not well understood. Surgery has a defined role and should not be discounted completely. Data were obtained from Medline publications citing 'anal fissure'. Manual cross-referencing of salient articles was conducted. We have sought to highlight various controversies in the management of anal fissures. Acute fissures may heal spontaneously, although simple conservative measures are sufficient. Idiopathic chronic anal fissures need careful evaluation to decide what therapy is suitable. Pharmacological agents such as glyceryl trinitrate (GTN), diltiazem and botulinum toxin have been subjected to most scrutiny. Though practices in the UK vary, GTN or diltiazem would be suitable as first-line therapy with botulinum toxin used as rescue treatment. Sphincterotomy is indicated for unhealed fissures; fissurectomy has been revisited and advancement flaps have a role in patients in whom sphincter division is not suitable.

  11. 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) ...

  12. Modern Perspectives in the Treatment of Chronic Anal Fissures

    PubMed Central

    Bhardwaj, R; Parker, MC

    2007-01-01

    INTRODUCTION Anal fissures are commonly encountered in routine colorectal practice. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. Simple measures are often effective for early fissures. Glyceryl trinitrate is well established as a first-line pharmacological therapy. The roles of diltiazem and botulinum, particularly as rescue therapy, are not well understood. Surgery has a defined role and should not be discounted completely. METHODS Data were obtained from Medline publications citing ‘anal fissure’. Manual cross-referencing of salient articles was conducted. We have sought to highlight various controversies in the management of anal fissures. FINDINGS Acute fissures may heal spontaneously, although simple conservative measures are sufficient. Idiopathic chronic anal fissures need careful evaluation to decide what therapy is suitable. Pharmacological agents such as glyceryl trinitrate (GTN), diltiazem and botulinum toxin have been subjected to most scrutiny. Though practices in the UK vary, GTN or diltiazem would be suitable as first-line therapy with botulinum toxin used as rescue treatment. Sphincterotomy is indicated for unhealed fissures; fissurectomy has been revisited and advancement flaps have a role in patients in whom sphincter division is not suitable. PMID:17688717

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

    PubMed

    Aslam, Muhammad I; Pervaiz, Arif; Figueiredo, Rodrigo

    2014-01-01

    Anal fissure is a common benign condition. An anorectal problem is defined as a split in the anal canal mucosa that extends from the dentate line to the anal verge. Chronic anal fissure is defined by a history of symptoms present for more than 2 months' duration and with a triad of external skin tags, namely, a hypertrophied anal papilla, an ulcer with rolled edges, and a base exposing the internal sphincter. Because complications such as incontinence are associated with surgical treatment, chemical sphincterotomy is currently favored. The objective of this study is to compare the difference in outcome between open partial lateral anal sphincterotomy and application of topical 0.2% nitroglycerin ointment for the treatment of chronic anal fissure. This was a quasi-experimental study carried out between January 16, 2007 and January 15, 2008 in the Surgical Department of Jinnah Hospital, Lahore, Pakistan. Sixty consecutive cases with a clinical diagnosis of chronic anal fissure were recruited in the study. All recruited patients met the study inclusion criteria and were randomly assigned to one of the two groups. Group A was managed conservatively using topical 0.2% nitroglycerin ointment, whereas Group B underwent open partial lateral anal sphincterotomy. Both groups were followed up at 1 week, 2 weeks, 4 weeks, and 6 weeks after the treatment. All the patients complained of pain. A total of 43 (71.7%) patients had pain with constipation, whereas 31 (51.7%) patients had bleeding per rectum. Upon clinically examining the anal area, tenderness was elicited in all 60 (100%) patients. Group A included 30 (11 females and 19 males) cases treated with topical 0.2% nitroglycerin ointment and Group B included 30 (11 females and 19 males) cases who underwent open partial lateral anal sphincterotomy. In Group A, only 15 patients with fissures were successfully treated (50%). By contrast, 28 (93%) patients with fissures in Group B were successfully treated, and only two (7

  14. Low energy manual anal stretch: an approach in the treatment of chronic anal fissure.

    PubMed

    Gaj, Fabio; Biviano, Ivano; Candeloro, Laura

    2017-04-01

    Anal fissure is a tear in the epitelial lining of the anal canal. This is a very common anorectal disorder, but the choice of treatment is unclear. Sphincterotomy is effective but it is affected by a high risk of fecal incontinence. Manual anal stretch is aN efficacious, economic and safe maneuver. The aim of this prospective study was to assess the safety and effectiveness of anal stretch in resolving chronic anal fissures. Twenty-five patients with a clinical diagnosis of chronic anal fissure were submitted to anal stretch. All patients were submitted to anal stretch, after clinical evaluation. All patients were studied at basal time, and at 7 days, 3, 6 and 12 months after the treatment. At 3 months and 6 months after the anal stretch, 88% and 94% of patients showed a resolution of anal fissures and only 12% have relapsed at 12 months, without complications, such as faecal incontinence. The anal stretch appears to induce better resolution of chronic anal fissure with a very low risk of fecal incontinence.

  15. Lateral internal sphincterotomy for surgically recurrent chronic anal fissure.

    PubMed

    Liang, Jennifer; Church, James M

    2015-10-01

    Lateral internal sphincterotomy cures chronic anal fissure by preventing internal sphincter hypertonia. However, cutting sphincter predisposes to sphincter dysfunction, manifests as incontinence of gas, liquid, or stool. Surgeons, therefore, can be too cautious in its use, making ineffective superficial incisions or avoiding the operation altogether. This study is designed to confirm the role of redo lateral internal sphincterotomy in the treatment of surgically recurrent chronic anal fissure. Patients undergoing repeat lateral internal sphincterotomy for surgically recurrent chronic anal fissure were accessed from a prospectively maintained database. Chronicity was defined by symptoms persisting more than 3 weeks. Contralateral sphincterotomy was performed with electrocautery through a stab incision over the intersphincteric plane. The length of sphincter division was the same as the length of the fissure. Phone questionnaire was administered and fecal continence was assessed by modified Cleveland Clinic Incontinence Score. Patients were asked to rank their overall satisfaction with the operation, and pre- and postoperative quality of life. There were 57 patients, 24 women and 33 men; mean age was 47.9 ± 14.8 years. Mean follow-up was 12.5 ± 4.2 years (range 6.2 to 25.2 years). Presenting symptoms included pain (100%), bleeding (80%), pruritus ani (39%), constipation (26%), and diarrhea. Fifty patients (90%) presented with 1 fissure, and 40 were posterior. Most procedures were performed on an outpatient basis. Fissure healing rate was 98%, and 2 patients (4%) developed minor incontinence postoperatively (one of gas, the other, gas and seepage). Overall satisfaction was 9.7 ± .9 out of 10 with a significant improvement in the quality of life from 5.7 ± 2.4 out of 10 to 9.3 ± 1.4 out of 10 (P < .001). Judicious repeat lateral sphincterotomy cures recurrent chronic fissures with minimal risk of incontinence. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Innovations in chronic anal fissure treatment: A systematic review

    PubMed Central

    Poh, Aaron; Tan, Kok-Yang; Seow-Choen, Francis

    2010-01-01

    A chronic anal fissure is a common perianal condition. This review aims to evaluate both existing and new therapies in the treatment of chronic fissures. Pharmacological therapies such as glyceryl trinitrate (GTN), Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option, but with higher recurrence rates. Lateral sphincterotomy remains the gold standard for treatment. Anal dilatation has no role in treatment. New therapies include perineal support devices, Gonyautoxin injection, fissurectomy, fissurotomy, sphincterolysis, and flap procedures. Further research is required comparing these new therapies with existing established therapies. This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy. Perineal support may offer a new dimension in improving healing rates. Lateral sphincterotomy should be offered if pharmacological therapy fails. New therapies are not suitable as first line treatments, though they can be considered if conventional treatment fails. PMID:21160880

  17. Identifying the best therapy for chronic anal fissure

    PubMed Central

    Madalinski, Mariusz H

    2011-01-01

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

  18. Morbidity associated with treatment of chronic anal fissure

    PubMed Central

    Latif, Ansar; Ansar, Anila; Butt, Muhammad Qasim

    2013-01-01

    Objective: To assess the effectiveness of different modes of treatment of chronic anal fissure as regards improvement of symptoms and complications. Methods: This prospective study included 129 consecutive patients with chronic anal fissures presented to the Surgical Outpatients’ Department of Islam Teaching Hospital Sialkot, Pakistan; from September 2010 to November 2012. Patients were distributed in three groups. In “OBG group”, patients had attended Gynae/Obs OPD and got treated and were then referred to surgical OPD for failure of treatment or recurrence. Patients who presented with history of treatment by GPs were included in “GP Group” “SGR Group” included those who directly reported to surgical OPD for treatment. Patients were managed both pharmacologically as OPD patients and surgically as admitted patients. Patients were instructed to apply small amounts of 0.2% GTN paste in soft white paraffin, to the anoderm with finger tips three times a day. Patients were evaluated at two-week intervals and at each visit the symptoms control, adverse effects and fissure status were recorded. If there was symptomatic relief or the fissure healing was in progress, the treatment was continued for a total duration of eight weeks. Operated patients were nursed in wards after surgery i.e Internal Anal Sphicterotomy. They were advised to report to OPD weekly for one month or earlier if they experienced any symptoms suggestive of complications. Patients were declared cured in case of complete symptomatic relief with fissure healing. Success, failure and associated problems were recorded and analysed to get results. Results:This study included 129 patients who could be followed up for a minimum of three months. These patients were referred by gynaecologist i.e. 22 (17%) for treatment failure while 5 patients with wrong diagnosis were not included in statistical analysis; similarly 41 (32%) patients were referred by general practitioners and 9 patients with wrong

  19. Combined approach in the treatment of chronic anal fissures.

    PubMed

    Vershenya, S; Klotz, J; Joos, A; Bussen, D; Herold, A

    2015-03-01

    This study was designed to evaluate the healing and complications rates in surgically and conservatively treated patients with chronic anal fissure. Conservative treatment consisted of nitrate or diltiazem ointment. In case of surgery, fissurectomy was performed. In total, 340 patients were included in the study. Among them, 162 patients had surgery and 178 patients had conservative treatment. The healing rate at surgically treated group of patients varied between 95 and 98% depending on previous treatment. Group treated with nitrate ointment and group treated with diltiazem ointment showed, respectively 62% and 52% healing rates. Difference between ointments was not statistically significant. Average healing time was between 105 and 123 days and complication rates were between 1.7 and 5.4%. The surgical treatment showed much higher healing rates and thus should recommended as primary treatment option for the chronic anal fissure, especially if there are chronic secondary lesions already present. In case of conservative treatment, either nitrate or diltiazem ointment could be used with similar efficacy.

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

    PubMed

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

    2017-02-01

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

  1. Pharmacological Sphincterotomy for Chronic Anal Fissures by Botulinum Toxin A

    PubMed Central

    Wollina, Uwe

    2008-01-01

    Chronic anal fissure is a common proctologic disease. Botulinum toxin (BTX) can be used for temporary chemical denervation to treat this painful disorder. Its application is by intramuscular injections into either the external or internal anal sphincter muscle. The mode of action, application techniques, and possible complications or adverse effects of BTX therapy are discussed in this report. The healing rate is dependent on the BTX dosage. The short-term healing rate (≤ 6 months) is 60–90%, whereas about 50% of the patients show a complete response in long-term follow-up studies (> 1 year). Adverse effects are generally mild, but relapses occur more often than with surgery. Conservative therapy is currently considered as a first-line treatment. With increasing evidence for its efficacy, BTX can now be considered among the first-line nonsurgical treatements. Although, surgical management by lateral sphincterotomy is the most effective treatment, it shows a higher incidence of incontinence and greater general morbidity rate than BTX. BTX is a useful alternative to surgery and in many cases, surgery can be avoided with the use of BTX. PMID:20300345

  2. Pharmacological sphincterotomy for chronic anal fissures by botulinum toxin a.

    PubMed

    Wollina, Uwe

    2008-07-01

    Chronic anal fissure is a common proctologic disease. Botulinum toxin (BTX) can be used for temporary chemical denervation to treat this painful disorder. Its application is by intramuscular injections into either the external or internal anal sphincter muscle. The mode of action, application techniques, and possible complications or adverse effects of BTX therapy are discussed in this report. The healing rate is dependent on the BTX dosage. The short-term healing rate ( 1 year). Adverse effects are generally mild, but relapses occur more often than with surgery. Conservative therapy is currently considered as a first-line treatment. With increasing evidence for its efficacy, BTX can now be considered among the first-line nonsurgical treatements. Although, surgical management by lateral sphincterotomy is the most effective treatment, it shows a higher incidence of incontinence and greater general morbidity rate than BTX. BTX is a useful alternative to surgery and in many cases, surgery can be avoided with the use of BTX.

  3. A study of hypertrophied anal papillae and fibrous polyps associated with chronic anal fissures.

    PubMed

    Gupta, Pravin J

    2004-06-01

    Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. However, they do cause a few disturbing symptoms. This study describes the advantages of the removal of such pathologies associated with chronic anal fissure. Following lateral anal sphincterotomy, the polyps or papillae were removed using a radio frequency device. A comparison before and after removal of the papillae or polyps was carried out for the associated complaints such as like pruritus, pricking sensation, wetness, crawling in the anus etc. In a separated randomized and prospective study, 80 patients were divided into two groups. 40 patients underwent only sphincterotomy, while in the remaining 40 patients, the papillae or polyps were removed after sphincterotomy. Symptom comparison was made before and after the procedure at 6- month follow-up. After one month of the procedure, the associated symptoms were significantly reduced, with a near total decline in the primary complaints of pain and bleeding. There was significant reduction in conditions like pruritus (p=0.0001), discharge per anus (p=0.0001), crawling sensation in the anus (p= 0.0006) and sense of incomplete evacuation (p= 0.0001). The prospective study confirmed the above findings. The above study establishes that removal of hypertrophied anal papillae and fibrous polyps should be routinely carried out during surgical treatment of anal fissure to add to effectiveness and completeness of the procedure.

  4. Anal sphincter fibrillation: is this a new finding that identifies resistant chronic anal fissures that respond to botulinum toxin?

    PubMed

    Moon, A; Chitsabesan, P; Plusa, S

    2013-08-01

    Anal fissures can be resistant to treatment and some patients may undergo several trials of medical therapy before definitive surgery. It would be useful to identify predictors of poor response to medical therapy. This study assesses the role of anorectal physiological criteria to identify patients with anal fissure predicted to fail botulinum toxin (BT) treatment. A retrospective analysis of anorectal physiological data collected for patients with resistant chronic anal fissures, referred to one consultant surgeon between 2007 and 2011, was undertaken. These were correlated with treatment plans and healing rates. Twenty-five patients with idiopathic chronic anal fissures underwent anorectal physiology studies and were subsequently treated with BT injection. Eleven had a characteristic high-frequency low-amplitude 'saw tooth' waveform or anal sphincter fibrillation (ASF) and higher anal sphincter pressures. Nine (82%) of these patients had resolution of their anal fissure symptoms following treatment with BT. Of 14 patients with no evidence of ASF and a greater range of anal sphincter pressures, only one (7%) had resolution following BT. ASF appears to be an anorectal physiological criterion that helps predict response of anal fissures to BT injection. This could help streamline fissure management. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  5. Management of complicated chronic anal fissures with high-dose circumferential chemodenervation (HDCC) of the internal anal sphincter.

    PubMed

    Whatley, James Z; Tang, Shou-Jiang; Glover, Porter H; Davis, Eric D; Jex, Kellen T; Wu, Ruonan; Lahr, Christopher J

    2015-12-01

    Botulinum toxin injection into the internal anal sphincter (IAS) is gaining popularity as a second line therapy for chronic anal fissures after patients fail medical therapy. The dosage of Botulinum toxin reported in the literature ranged from 20 to 50 IU. Complicated chronic anal fissure is defined as persistent fissure concurrent with other perianal pathology. We report a new approach involving high-dose circumferential chemodenervation (HDCC) of 100 IU in treating these complicated chronic anal fissures. The aim of this study was to evaluate the fissure healing, complication, and recurrence rates with HDCC. Complicated anal fissure was defined as fissure with other perianal pathologies including skin tag, hypertrophied papilla, fistula, symptomatic hemorrhoids, anal condylomata, and abscess. Between 2008 and 2012, 62 consecutive patients (28 Blacks, 33 Whites, 1 Hispanic) with complete follow-up data were included in this single arm study. These patients underwent HDCC-IAS with addition interventions by a single colorectal surgeon. Follow up data were obtained by chart review and office follow up. Of the 62 patients, the overall success rate was greater than 70% at 3 months follow-up. A few patients developed transient flatus or fecal incontinence, but shortly resolved. There was no major complication following HDCC-IAS. Combination therapy involving HDCC-IAS and local anorectal surgery for associated condition is both safe and effective for fissure healing. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  6. Effect of topical glyceryl trinitrate on anodermal blood flow in patients with chronic anal fissures.

    PubMed

    Kua, K B; Kocher, H M; Kelkar, A; Patel, A G

    2001-09-01

    Recent studies have highlighted the role of increased internal anal sphincter pressure and decreased anodermal blood flow in the pathogenesis of chronic anal fissures. The duration of the effect of topical 0.2% glyceryl trinitrate (GTN) ointment on anodermal blood flow in fissure and normal areas was investigated in patients with chronic anal fissures. Six patients with chronic anal fissures in the posterior midline participated in the study. Blood flow measurements were performed on the anoderm using laser Doppler flowmetry before and immediately after the topical application of 0.2% GTN ointment and subsequent readings were taken at 5, 15, 30, 45 and 60 min in all four quadrants. The mean anodermal blood flow in the fissure region is significantly lower than the mean blood flow of the rest of the anoderm before 0.2% GTN ointment is applied (228.7 +/- 61.8 flux units vs 439.3 +/- 25.5 flux units, respectively; P < 0.05). Immediately after the application of local 0.2% GTN ointment there is a significant increase in anodermal blood flow over the anal fissure region (457.8 +/- 56.5 flux units; P < 0.05) compared to the rest of the anoderm (457.4 +/- 30.8 flux units). This increase is most marked at 5 min post-GTN ointment application in the fissure area (474.6 +/- 41.1 flux units) and the blood flow in the fissure region is consistently above the rest of the anoderm for most of the 60 min. There is clearly reduced blood flow to the chronic anal fissure region compared to the rest of the anoderm. Topical application of glyceryl trinitrate ointment seems to significantly improve the blood flow to the fissured area in the first hour. This may therefore help in the healing of chronic anal fissures.

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

    PubMed

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

    2016-09-01

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

  8. V-Y advancement flap as first-line treatment for all chronic anal fissures.

    PubMed

    Chambers, William; Sajal, Rai; Dixon, Anthony

    2010-05-01

    It was suggested that anal advancement flap be used to treat patients with chronic anal fissures that have failed medical management and have a low-pressure sphincter complex. We wished to assess anal advancement flap as a treatment for all chronic anal fissures. All patients with chronic anal fissures regardless of their previous management underwent V-Y advancement flap. Patient demographics, symptom duration, previous treatments, short-term postoperative outcome and long-term follow-up were recorded. Fifty-four consecutive patients, median age 39 years (22-66), underwent a V-Y advancement flap over a 7-year period; 34 were men. Duration of symptoms ranged from 2 to 36 months with a median of 8 months. Forty-two patients (78%) had failed a previous therapy: glyceryl trinitrate (GTN) (25), GTN and diltiazem (16) and lateral sphincterotomy (one). Wound dehiscence occurred in three patients of which only one required a surgical intervention. On follow-up at 6 months, all but one patient had a healed wound and was asymptomatic. We have shown excellent rates of healing of chronic anal fissures treated with a V-Y advancement flap regardless of sphincter pressures, previous treatment and symptom chronicity. These results show the technique can be applied to all chronic fissures with success and used as a primary therapy.

  9. Anal fissure - slideshow

    MedlinePlus

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

  10. A randomized trial of oral vs. topical diltiazem for chronic anal fissures.

    PubMed

    Jonas, M; Neal, K R; Abercrombie, J F; Scholefield, J H

    2001-08-01

    Chemical sphincterotomy has proved effective in treating chronic anal fissure. Glyceryl trinitrate is the most widely used agent, and topical 0.2 percent glyceryl trinitrate ointment heals up to two thirds of chronic anal fissures. Unfortunately, however, many patients experience troublesome headaches as a side effect of this treatment. This study assessed the effectiveness of oral and topical diltiazem in healing chronic fissures. Fifty consecutive patients with chronic anal fissures were randomly assigned to receive oral (60 mg) or topical (2 percent gel) diltiazem twice daily for up to eight weeks. Anal manometry was performed before and after the first dose, and blood pressure was recorded at 15-minute intervals. Patients were reviewed fortnightly, pain was expressed with a visual linear analog scale, blood pressure was recorded, fissure healing was assessed, and side effects were noted. Twenty-four patients received oral diltiazem, and 26 received topical diltiazem. Mean (+/- standard error of the mean) maximum resting anal pressures fell by 15 and 23 percent from 95 +/- 4 to 81 +/- 4 and from 102 +/- 5 to 79 +/- 5 cm H2O in the two groups, respectively. There was no significant reduction in blood pressure during the study or at follow-up in either group. Fissure healing was complete in 9 patients (38 percent) receiving oral diltiazem and 15 (65 percent) on topical treatment by eight weeks. Oral diltiazem caused side effects in eight patients (rash, two; headaches, two; nausea or vomiting, three; reduced smell and taste, one), whereas no side effects were seen in those receiving topical therapy (P = 0.001). Oral and topical diltiazem heal chronic anal fissures. Topical diltiazem is more effective, achieving healing rates comparable to those reported with topical nitrates, with significantly fewer side effects.

  11. [Treatment of chronic anal fissures: diltiazem or isosorbide dinitrate as first choice?].

    PubMed

    Boeker, Eveline B; Kruijer, M J P Marjan; Verbeek, Paul C M

    2011-01-01

    Chronic anal fissures are a painful condition frequently seen in general practice, with an incidence of 2,5/1000 per year. According to the practice guidelines of the Dutch College of General Practitioners, isosorbide dinitrate 1% ointment (ISDN) is the treatment of first choice for chronic anal fissures. Systemic side-effects such as headache are reported in 27% of all cases. This side effect in combination with the frequent application of ISDN (4-6 times daily) leads to a low compliance for this therapy. A meta-analysis of the Cochrane Collaboration showed similar efficacy of diltiazem compared to ISDN. Diltiazem has several advantages: the application frequency is only twice daily, no systemic side-effects have been reported, the total costs of treatment are lower than the costs of ISDN and a standard preparation of diltiazem ointment is available. Therefore, diltiazem 2% ointment should be the first line treatment for chronic anal fissures.

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

    PubMed Central

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

    2013-01-01

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

  13. Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures: a prospective study.

    PubMed

    Jonas, Marion; Speake, William; Scholefield, John H

    2002-08-01

    Both topical diltiazem, a calcium channel blocker, and glyceryl trinitrate, a nitric oxide donor, lower anal pressure and heal two-thirds of chronic anal fissures. This study evaluated the efficacy of diltiazem for fissures that failed to heal with glyceryl trinitrate. Consecutive patients with persistent chronic fissures despite treatment with 0.2 percent glyceryl trinitrate ointment underwent anal manometry before and for 1 hour after application of 700 mg of 2 percent diltiazem gel to the distal anal canal. Patients applied diltiazem twice daily for eight weeks or until the fissure had healed. At fortnightly review, fissure healing was assessed, and side effects were noted. Patients scored symptoms of pain, bleeding, and irritation using linear visual analog scales at the initial and follow-up visits. In 39 patients (13 males; median age, 42 (range, 20- 80) years), topical 2 percent diltiazem gel lowered anal resting pressure by 20 percent from a median of 93 to 74 cm H2O (P < 0.0001, Wilcoxon), and fissures healed in 19 (49 percent) within 8 weeks. Before diltiazem, 27 patients (69 percent) had used a complete course of glyceryl trinitrate (0.5 g twice daily for 8 weeks), and 12 (44 percent) of these healed with diltiazem. The remaining 12 patients had discontinued glyceryl trinitrate prematurely or used less because of headaches; 7 (58 percent) of these healed with diltiazem, and 5 (42 percent) did not. Side effects occurred in four patients (10 percent): three reported perianal itching but continued with treatment, and one developed headaches, drowsiness, and mood swings six weeks into treatment and stopped diltiazem at that time. Topical 2 percent diltiazem is effective treatment for glyceryl trinitrate-resistant chronic anal fissures. Side effects, mainly perianal itching, may occur in 10 percent of patients but are generally tolerated.

  14. [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.

  15. Early results of a rotation flap to treat chronic anal fissures.

    PubMed

    Singh, Meheshinder; Sharma, Abhiram; Duthie, Graeme; Balasingh, Davaraj; Kandasamy, P

    2005-07-01

    Treatment of anal fissures has changed dramatically in the past decade. This is primarily due to a better understanding of its pathophysiology and the implications of the various available options. Only a few anal fissures fail to respond to medical therapy. Sphincterotomy and anal dilatation have fallen out of favour due to the risk of incontinence. Island flaps have been proposed to address this, but 60-70% of the flap donor sites break down with complications. We propose using a rotation flap to overcome this problem. A local rotation flap from perianal skin was used to fill the fissure defect in 14 patients who were followed up for a period of 6 months to determine fissure healing and incidence of donor site breakdown. Twelve patients had complete resolution of their symptoms. Of two patients who developed fissure recurrence, one also had dehiscence of the donor site. There were no donor site complications in the remaining patients. No patient suffered continence defects as a result of the surgery. Rotation flap is a simple, safe and appropriate modality for treating chronic anal fissures. Donor site problems are avoided using this approach. It should be the treatment of choice, particularly in patients who are at risk of incontinence.

  16. Glyceryl trinitrate ointment (0.25%) and anal cryothermal dilators in the treatment of chronic anal fissures.

    PubMed

    Schiano di Visconte, Michele; Munegato, Gabriele

    2009-07-01

    Chronic anal fissure is a common benign disorder; for this condition, lateral internal sphincterotomy is the "gold standard" of treatment. Alternative medical treatments have not proven to be as effective as left lateral internal sphincterotomy. This randomized trial was designed to compare the use of 0.25% glyceryl trinitrate ointment and anal cryothermal dilators with the use of 0.4% glyceryl trinitrate ointment alone in the treatment of chronic anal fissures. Between 1 June 2006 and 31 December 2007, 60 consecutive patients who were suffering from chronic anal fissures were randomized into two groups. The patients in group A (n = 30) were treated with 0.25% glyceryl trinitrate ointment and anal cryothermal dilators twice daily, and those in group B (n = 30) were treated with 0.4% glyceryl trinitrate ointment alone twice daily. The treatment was administered to the patients in each group for 6 weeks, and all patients were examined 7 weeks after the start of the trial. Prior to treatment, the symptoms and the measurements of anal pressure were similar in both groups. At 7 weeks, the maximum resting pressure was significantly lower in group A (P < 0.05), in which 86.6% of the patients were asymptomatic in comparison with 73.3% of the patients in group B. After 1 year of follow-up, 25 patients (83.3%) in group A and 18 patients (60%) in group B presented no recurrence of symptoms (P < 0.05) Treatment of chronic anal fissures with 0.25% glyceryl trinitrate ointment and anal cryothermal dilators was more effective than the administration of 0.4% glyceryl trinitrate ointment alone.

  17. Fissurectomy combined with botulinum toxin A injection for medically resistant chronic anal fissures.

    PubMed

    Witte, M E; Klaase, J M; Koop, R

    2010-07-01

    Chemical sphincterotomy, the use of pharmacological agents to reduce anal sphincter resting pressure, has become more and more popular in the treatment of chronic anal fissures (CAFs). It offers the possibility to avoid a lateral internal sphincterotomy and its associated risk of incontinence. In our hospital, patient with a chronic anal fissure are consecutively treated with isosorbide dinitrate 1% ointment, applied 6 times a day for 8 weeks, followed by diltiazem 2% ointment, applied 2 times a day for 8 weeks and Botulin Toxin A injections (Dysport; Ipsen, Hoofddorp, the Netherlands) in the internal anal sphincter. In a previous study (1), we describe high healing rates with this regime. Objective The objective of this study is to evaluate the effect of the combination of fissurectomy and Botulin Toxin A in the treatment of CAFs. Twenty-one patients (10 male patients, median age 48 years) with persistent symptoms of chronic anal fissures after following the above mentioned treatment, were enrolled in this study. Fissurectomy was combined with Botulinum Toxin A (80 U of Dysport) under regional anaesthesia in day care. Results After 12 weeks 19/21 CAFs (90%) had healed. Median follow-up was 16 (9-30) months. No recurrences were seen. Fissurectomy in combination with Botulinum Toxin A injection in the internal anal sphincter is an effective treatment for medically resistant CAFs.

  18. Increasing efficacy and reducing side effects in treatment of chronic anal fissures

    PubMed Central

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

    2017-01-01

    Abstract This is a single institution nonexperimental study intended to analyze the therapeutic efficacy of topical diazepam in treating symptoms of chronic anal fissures. Anal fissures are a common cause of anal pain. Conventional treatments include nonsteroidal anti-inflammatory drugs, topical creams, such as nitroglycerin and nifedipine, and surgery. However, these treatments are usually suboptimally efficacious or have deterring side effects. Patients at an outpatient community center with a diagnosis of a chronic anal fissure were prescribed either topical 2% (n = 19) or 4% (n = 18) diazepam cream between January 2013 and February 2015. We retrospectively analyzed their responses to treatment. All 19 patients using 2% diazepam cream experienced a positive response in pain, whereas 47.4% experienced a complete response, with a numerical rating scale (NRS) score of 0 (0–10). Eighty-eight percent of patients using 4% dose had a positive response in pain, whereas 23.5% experienced a complete response. Ninety-four percent of patients using 2% dose had a positive response in anal bleeding, whereas 68.8% experienced a complete response with an anal bleeding score (ABS) of 2 (2–9). Ninety-four percent of patients using 4% dose had a positive response in anal bleeding, whereas 64.7% experienced a complete response. Only 1 patient reported a side effect from diazepam cream—perianal pruritus. Both 2% and 4% topical diazepam provided significant pain and bleeding relief from chronic anal fissures that were refractory to conventional therapies. There were insignificant differences when assessing independent comparisons for pain and bleeding between the doses. PMID:28514300

  19. Early results of a rotational flap to treat chronic anal fissures.

    PubMed

    Singh, Meheshinder; Sharma, Abhiram; Gardiner, Angela; Duthie, Graeme S

    2005-07-01

    Treatment of anal fissures has changed dramatically in the past decade. Only a few fail to respond to medical therapy. Sphincterotomy and anal dilatation have fallen out of favour due to the risk of incontinence. Island flaps have been proposed to address this, but 60--70% of flap donor sites break down with complications. We proposed that using a rotational flap would overcome this problem. Twenty-one patients (14 women,7 men) with chronic anal fissures were treated with rotation flap from perianal skin. The median age was 43 (range 21--76) years. All patients had failed chemical sphincterotomy and showed no signs of improvement following at least a 3-month course of topical GTN 0.2% ointment. The median hospital stay was 2 days. Seventeen patients had complete resolution of symptoms. Only one patient continued to have severe pain. Two developed a recurrent fissure. One patient had a combined fistula-fissure complex at diagnosis and suffered from a breakdown of the flap and donor site. Another patient had had haemorrhoidectomy and an advancement flap in the past. He developed problems with the donor site, which was successfully managed conservatively. One patient had persistent mild pain after surgery, but the cause could not be found. None of the patients suffered continence defects after surgery. Use of a rotational flap is a simple, safe and successful treatment for anal fissures. Donor site problems are minimised using this approach. It should be a treatment of choice when surgery is required for chronic anal fissures, particularly in patients in whom there is a risk of incontinence.

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

    PubMed

    Chaptini, Cassandra; Casey, Genevieve; Harris, Adam G; Wattchow, David; Gordon, Lynne; Murrell, Dedee F

    2015-12-01

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

  1. 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

  2. [Surgical therapy of chronic anal fissure--do additional proctologic operations impair continence?].

    PubMed

    Pfeifer, J; Berger, A; Uranüs, S

    1994-07-01

    78 patients with chronic anal fissures have been mainly operated on by lateral internal sphincterotomy (LATS). Continence have been evaluated by questionnaire at least 9 months postoperatively. Patient without any additional proctological operation had minor disturbances of continence in 17%. Patient with additional operations had disturbances of continence in 30%. Especially the subgroup of patients with LATS and haemorrhoidectomy had bad results. In this group only 45% were fully continent.

  3. Lateral Anal Sphincterotomy for Chronic Anal Fissures- A Comparison of Outcomes and Complications under Local Anaesthesia Versus Spinal Anaesthesia.

    PubMed

    Manoharan, Ravikumar; Jacob, Tarun; Benjamin, Santosh; Kirishnan, Sumonth

    2017-01-01

    Fissure-in-Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF). However, LAS is often done under spinal or general anaesthesia incurring huge treatment costs and hospital stay. To study if LAS can be treated with Local Anaesthesia (LA) thereby, reducing the costs and the anaesthetic risk to patients with no significant change in the surgical ease or clinical outcome. A total of 79 patients with chronic fissure underwent randomized allocation to two treatment arms - The first to undergo LAS under LA and the second under Spinal Anaesthesia (SA). The primary outcome variables studied were complications like post-operative pain, infections, healing rate of fissure and incontinence rates. Secondary outcome variables studied were cost, hospital stay and need for additional anaesthetic. A total of 79 patients underwent LAS procedure. A total of 42 patients had LA and 39 patients had SA. There was no statistically significant difference in the healing rate, pain, infection and incontinence rates between the two groups. Moreover, the LA group incurred lower cost, reduced hospital stay and reduced risk of anaesthesia. LAS can be satisfactorily performed under local anaesthesia with no increased risk of pain or complications, and is best suited for resource-poor surgical settings.

  4. Lateral Anal Sphincterotomy for Chronic Anal Fissures- A Comparison of Outcomes and Complications under Local Anaesthesia Versus Spinal Anaesthesia

    PubMed Central

    Jacob, Tarun; Benjamin, Santosh; Kirishnan, Sumonth

    2017-01-01

    Introduction Fissure-in-Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF). However, LAS is often done under spinal or general anaesthesia incurring huge treatment costs and hospital stay. Aim To study if LAS can be treated with Local Anaesthesia (LA) thereby, reducing the costs and the anaesthetic risk to patients with no significant change in the surgical ease or clinical outcome. Materials and Methods A total of 79 patients with chronic fissure underwent randomized allocation to two treatment arms – The first to undergo LAS under LA and the second under Spinal Anaesthesia (SA). The primary outcome variables studied were complications like post-operative pain, infections, healing rate of fissure and incontinence rates. Secondary outcome variables studied were cost, hospital stay and need for additional anaesthetic. Results A total of 79 patients underwent LAS procedure. A total of 42 patients had LA and 39 patients had SA. There was no statistically significant difference in the healing rate, pain, infection and incontinence rates between the two groups. Moreover, the LA group incurred lower cost, reduced hospital stay and reduced risk of anaesthesia. Conclusions LAS can be satisfactorily performed under local anaesthesia with no increased risk of pain or complications, and is best suited for resource-poor surgical settings.

  5. Treatment of chronic anal fissures and associated stenosis by autologous adipose tissue transplant: a pilot study.

    PubMed

    Lolli, Paola; Malleo, Giuseppe; Rigotti, Gino

    2010-04-01

    A substantial body of recent evidence suggests that autologous adipose tissue transplant promotes healing in different lesions associated with local ischemia. We report the outcome of lipoaspirate transplant in hard-to-treat chronic anal fissures. Eight patients were included in this pilot study, 5 with single and 3 with multiple fissures. All had intense anal pain and had previously undergone proctologic surgery, with internal sphincterotomy performed in 6 patients. Severe stenosis was present in 3 patients and moderate stenosis in 2. Preoperative assessment included anoscopy, anorectal manometry, colonoscopy, and microbiological tests to exclude inflammatory, neoplastic, or infectious diseases. Surgical treatment consisted of transplant of purified autologous fat retrieved from the hypogastrium. Follow-up was scheduled after 1 week, at 2, 3, 6, and 12 months, and thereafter on a yearly basis. All of the patients were discharged several hours after surgery. No early postoperative complication was observed. Complete healing and pain remission were achieved in 6 patients (75%), 4 of whom were treated in a single session, whereas 2 patients required 2 and 3 sessions. Anal stenosis was resolved in 4 of 5 patients (80%). The therapy was unsuccessful in 2 patients (25%). Mean follow-up was 18 months (range, 3-36 months). Perianal autologous fat transplant can be safely performed for the treatment of complex anal fissures. It is well tolerated and offers encouraging results, although further research is warranted because of the small number of patients treated and the relatively short follow-up time.

  6. Long-term follow-up after combined fissurectomy and Botox injection for chronic anal fissures.

    PubMed

    Scholz, Th; Hetzer, F H; Dindo, D; Demartines, N; Clavien, P A; Hahnloser, D

    2007-09-01

    Chronic anal fissures are difficult to treat. The aim of this retrospective study was to determine the outcome of combined fissurectomy and injection of botulinum toxin Type A (BT). Between January 2001 and August 2004, 40 patients (21 women), median age 37 years (range 18 to 57), underwent fissurectomy and BT injection. Fissurectomy was performed followed by injection of 10 U of BT into the internal anal sphincter on both sides of the fissure. All patients were clinically checked 6 weeks after the operation. At 1 year, patients were sent a detailed questionnaire regarding symptoms, recurrence and further treatment for evaluation of long-term results. At 6 weeks, 38 patients (95%) were free of symptoms. No adverse effects were detected. The response rate of questionnaires was 93%; the median follow-up was 1 year (range 0.9 to 1.6). In the long-term, a recurrence was found in four patients. These patients were treated successfully with repeated fissurectomy and BT injections and salvage procedures, respectively. Overall, the success rate of combined fissurectomy and BT injection was 79%. Combined fissurectomy and Botox injection for chronic anal fissure is an excellent and safe procedure with low morbidity and a high healing rate.

  7. [Mucosa advancement flap anoplasty in treatment of chronic anal fissures: a prospective, multicenter, randomized controlled trial].

    PubMed

    Wang, Zhen-yi; Liu, Hua; Sun, Jian-hua; Mao, Xu-ming; Xu, Wei-xiang; Wu, Ying-ge; Zhang, Hai-yan; Zhu, Li-juan; Jin, Wei; Wu, Jiong; Li, Ying; Wu, Chuang; Jiang, Zai-long; Shi, Li; Li, Yan; Dong, Wei

    2011-04-01

    Anal fissure is one of the most common anal-rectum diseases, and approximately 10 percent patients with chronic anal fissure ultimately receive surgery. Relieving postoperative pain and protecting functions of the sphincter are central issues for coloproctologists. To evaluate the efficacy and safety of anoplasty in the treatment of chronic anal fissures. In this prospective, multicenter, randomized controlled trial, 120 adult patients with chronic anal fissure were referred from Department of Coloproctology of Yueyang Hospital of Integrated Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Shanghai Municipal Hospital of Traditional Chinese Medicine. The patients were enrolled from January 2009 to April 2010 and randomly divided into study (mucosa advancement flap anoplasty, abbreviated as anoplasty) group and control (fissurectomy) group. The two groups were assessed separately, and the main outcome measures were observed for 2 weeks, with a short-term follow-up for 6 weeks. Degree of pain, haemorrhage and anal canal pressure were observed and recorded preoperatively, and on the third day, the fourteenth day and the sixth week postoperatively. The wound healing time was also recorded. Surgical complications of the two groups were recorded and compared on the third day and the sixth week postoperatively. The curative effects associated with the surgery were analyzed on the fourteenth day and the sixth week after surgery and the therapeutic results were evaluated. Three patients were dropped out due to the early discharge from hospital and losing connection (1 in study group and 2 in control group). Overall the surgery showed that the anoplasty group had better results than the fissurectomy group in the curative effect on the sixth week after operation (P<0.05). Time of wound healing in the anoplasty group was (17.22 ± 4

  8. Chronic anal fissure: 1994 and a decade later--are we doing better?

    PubMed

    Floyd, Nadine Duhan; Kondylis, Laurie; Kondylis, Philip D; Reilly, John C

    2006-03-01

    Debate exists regarding whether the use of topical agents and Botox injections are as efficacious as sphincterotomy for the treatment of chronic anal fissure. A retrospective review was performed to assess changes in management and outcomes of chronic anal fissure care in a community based colorectal practice between the individual years 1994 and 2003. Forty-seven patients in 1994 underwent lateral partial internal sphincterotomy and had a 100% healing rate. Thirty-nine patients were treated in 2003, with 32 undergoing Botox injection and 7 undergoing sphincterotomy initially. Of the Botox patients, 35% had recurrence, and 7 subsequently required sphincterotomy. Ultimate healing rates in 2003 were 97%. Time to heal was markedly prolonged in 2003 compared with 1994. Complication rates were similar, and there was no lifestyle-altering incontinence. Our review documents a significant change in the community approach to chronic fissure management. The addition of multiple treatment modalities prolongs time to healing from initial evaluation, but they allowed 72% of patients to avoid the need for permanent sphincter division while maintaining ultimate rates of healing.

  9. Randomized clinical trial of transcutaneous electrical posterior tibial nerve stimulation versus lateral internal sphincterotomy for treatment of chronic anal fissure.

    PubMed

    Youssef, Tamer; Youssef, Mohamed; Thabet, Waleed; Lotfy, Ahmed; Shaat, Reham; Abd-Elrazek, Eman; Farid, Mohamed

    2015-10-01

    The objective of this study was to evaluate the efficacy of transcutaneous electrical posterior tibial nerve stimulation in treatment of patients with chronic anal fissure and to compare it with the conventional lateral internal sphincterotomy. Consecutive patients with chronic anal fissure were randomly allocated into two treatment groups: transcutaneous electrical posterior tibial nerve stimulation group and lateral internal sphincterotomy group. The primary outcome measures were number of patients with clinical improvement and healed fissure. Secondary outcome measures were complications, VAS pain scores, Wexner's constipation and Peascatori anal incontinence scores, anorectal manometry, and quality of life index. Seventy-three patients were randomized into two groups of 36 patients who were subjected to transcutaneous electrical nerve stimulation and 37 patients who underwent lateral internal sphincterotomy. All (100%) patients in lateral internal sphincterotomy group had clinical improvement at one month following the procedure in contrast to 27 (75%) patients in transcutaneous electrical nerve stimulation group. Recurrence of anal fissure after one year was reported in one (2.7%) and 11 (40.7%) patients in lateral internal sphincterotomy and transcutaneous electrical nerve stimulation groups respectively. Resting anal pressure and functional anal canal length were significantly reduced after lateral internal sphincterotomy. Transcutaneous electrical posterior tibial nerve stimulation for treatment of chronic anal fissure is a novel, non-invasive procedure and has no complications. However, given the higher rate of clinical improvement and fissure healing and the lower rate of fissure recurrence, lateral internal sphincterotomy remains the gold standard for treating chronic anal fissure. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  10. [CHANGES OF HISTOSTRUCTURE OF CHRONIC ANAL FISSURE, DEPENDING ON DURATION OF THE DISEASE].

    PubMed

    Tamm, T I; Tsodikov, V V; Sedak, V V; Pliten, O N; Miroshnichenko, M S

    2016-01-01

    The results of histological investigation of the chronic anal fissure (AF) edges in 95 patients with the disease duration from 6 mo to 4.5 yrs were analyzed. Basing on estimation of severity of an acute inflammation signs and the granulation and cicatricial tissue presence there was established, that duration of an acute inflammation in the AF may constitute up to 6 - 7 mo; subacute--from 8 to 11 mo, chronic cicatricial process was observed in terms from 12 mo and more.

  11. Quality of life in patients with chronic anal fissure after topical treatment with diltiazem

    PubMed Central

    Tsunoda, Akira; Kashiwagura, Yasuharu; Hirose, Ken-ichi; Sasaki, Tadanori; Kano, Nobuyasu

    2012-01-01

    AIM: To assess the physical and mental health of fissure patients before and after topical treatment with diltiazem. METHODS: Consecutive patients were enrolled prospectively into the study. Quality of life was measured with the short-forum 36 health survey (SF-36) before and after 6-wk treatment with diltiazem. Patients scored symptoms of pain, bleeding, and irritation using numeral rating scales at the initial and follow-up visits. Fissure healing was assessed and side effects were noted. RESULTS: Fissures healed in 21 of 30 (70%) patients. There were significant reductions in the scores of pain, bleeding, and irritation after 1 wk of treatment, respectively. Four patients experienced perianal itching and one patient reported headache. When measured at baseline, pain and irritation showed a negative impact on two of the eight subscales on the SF-36, respectively (bodily pain and social functioning for pain; vitality and mental health for irritation). Repeating the SF-36 showed an improvement in bodily pain (P = 0.001). Patients whose fissures healed reported an improvement in bodily pain, health-perception, vitality, and mental health (P < 0.05). CONCLUSION: Successful treatment of chronic anal fissure with topical diltiazem leads to improvement in health-related quality of life. PMID:23494072

  12. The role of topical diltiazem in the treatment of chronic anal fissures that have failed glyceryl trinitrate therapy.

    PubMed

    Griffin, N; Acheson, A G; Jonas, M; Scholefield, J H

    2002-11-01

    The treatment of anal fissures has evolved over the last 5 years with the development of topical treatments aimed at reducing sphincter hypertonia. This is thought to improve anal mucosal blood flow and promote healing of the fissure. This study reports the use of topical diltiazem in patients with chronic anal fissures that have failed previous treatment with topical 0.2% glyceryl trinitrate (GTN). Forty-seven patients with chronic anal fissure who had previously failed at least one course of topical GTN were recruited prospectively from a single centre. Patients were instructed to apply 2 cm (approximately 0.7 g) of 2% diltiazem cream to the anal verge twice daily for eight weeks. Symptoms of pain, bleeding and itching were recorded on a linear analogue score prior to starting the cream and then repeated at 2 weekly intervals. Patients were asked to report side-effects throughout the study period. Healing of the fissure was assessed after 8 weeks of treatment. Forty-six patients completed treatment; of these, 22 had healed fissures (48%). Ten of the 24 patients with persistent fissures were symptomatically improved and wished no further treatment. Of the 14 patients who remained symptomatic, one was given a repeat course of 0.2% glyceryl trinitrate with subsequent healing of the fissure, 10 were recruited into an ongoing study involving injections of botulinum toxin into the internal anal sphincter and three were referred for surgery. This study shows that topical 2% diltiazem is an effective and safe treatment for chronic anal fissure in patients who have failed topical 0.2% GTN. The need for sphincterotomy can be avoided in up to 70% of cases.

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

    PubMed Central

    Giral, Adnan; Memişoğlu, Kemal; Gültekin, Yücel; İmeryüz, Neşe; Kalaycı, Cem; Ulusoy, Nefise B; Tözün, Nurdan

    2004-01-01

    Background Although lateral internal sphincterotomy is the gold-standard treatment for chronic anal fissure, intrasphincteric injection of botulinum toxin seems to be a reliable new option. The aim of this non-randomized study is to compare the effect of lateral internal sphincterotomy and botulinum toxin injection treatments on the outcome and reduction of anal sphincter pressures in patients with chronic anal fissure. Methods Patients with chronic anal fissure were treated with either botulinum toxin injection or lateral internal sphincterotomy by their own choice. Maximal resting pressure and maximal squeeze pressure measurements were performed before and 2 weeks after treatments by anal manometry. Patients were followed for fissure relapse during 14 months. Results Twenty-one consecutive outpatients with posterior chronic anal fissure were enrolled. Eleven patients underwent surgery and ten patients received botulinum toxin injection treatment. Before the treatment, anal pressures were found to be similar in both groups. After the treatment, the maximal resting pressures were reduced from 104 ± 22 mmHg to 86 ± 15 mmHg in the surgery group (p < 0.05) and from 101 ± 23 mmHg to 83 ± 24 mmHg in the botulinum toxin group (p < 0.05). The mean maximal squeeze pressures were reduced from 70 ± 27 mmHg to 61 ± 32 mmHg (p > 0.05) in the surgery group, and from 117 ± 62 mmHg to 76 ± 34 (p < 0.01) in the botulinum toxin group. The fissures were healed in 70 percent of patients in the botulinum group and 82 percent in the surgery group (p > 0.05). There were no relapses during the 14 months of follow up. Conclusion Lateral internal sphincterotomy and botulinum toxin injection treatments both seem to be equally effective in the treatment of chronic anal fissure. PMID:15035674

  14. High-dose circumferential chemodenervation of the internal anal sphincter: A new treatment modality for uncomplicated chronic anal fissure: A retrospective cohort study (with video).

    PubMed

    Glover, Porter H; Tang, Shou-jiang; Whatley, James Z; Davis, Eric D; Jex, Kellen T; Wu, Ruonan; Lahr, Christopher J

    2015-11-01

    Botulinum toxin injection into the internal anal sphincter is gaining popularity as a second line therapy for chronic anal fissures if medical therapy fails. The dosage of botulinum toxin reported ranged from 20 to 50 IU with no more than 3 injection sites and results in a healing rate of 41%-88% at 3 months. We propose a new injection method of high-dose circumferential chemodenervation of 100 IU in treating chronic anal fissure. This was a retrospective review at a single academic center. 75 patients (50 women and 25 men) with uncomplicated chronic anal fissures underwent high-dose circumferential chemodenervation-internal anal sphincter (100 IU). We measured fissure healing, complication, and recurrence rates at 3 and 6 months post injection. Of the 75 patients, healing rate was 90.7% at 3 months follow up with the first injection and 81.3% with the second injection. The recurrence rates were 20.6% and 12.5% at 6 months after the 1st and 2nd injections respectively. Excluding 5 patients who lost follow up, the total healing rate of the study cohort was 100%. At 2 weeks and 3 months, there were no major complications including hematoma, infection, flatus, fecal, and urinary incontinence. High-dose circumferential chemodenervation-internal anal sphincter (100 IU) is a safe and effective method for uncomplicated chronic anal fissure. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  15. [MORPHOGENESIS OF THE ANODERM STRUCTURAL CHANGES IN PATIENTS WITH CHRONIC ANAL FISSURES].

    PubMed

    Iftodiy, A; Kozlovska, I; Davydenko, I; Tiuleneva, E; Besedinska, E

    2015-09-01

    The objective of the study is to find peculiarities of the anoderm structural changes of morphogenesis in patients with chronic anal fissures (CAF) for further substantiation of therapeutic methods. The material of the study was the tissues of dissected anal complex (bottom and margins of ulcer, hypertrophic anal papilla, sentinel pile) from 33 patients. Histological examination found the defect of the stratified squamous epithelium. The epidermis of the marginal area of the wound, hypertrophic with signs of parakeratosis and acanthosis, hanged over the bottom. The surface of the bottom and margins of the wound in 31 cases (94%) was with thickening of rough fibrous masses. The bottom of ulcer in 29 (88%) cases is presented by sclerosed connective tissue. An increased amount of collagen fibers was found forming fuchsinophil is bundles. In 24 (73%) cases the scar on the fuchsine bottom of fissure was 3,4 mm (0,3±0,02) in deep. There are separate complexes of newly formed blood vessels with prevailing localization in the lateral walls of the wound. The blood vessels were with main by fibrosis in deep areas of the wound. Moderate interstitial edema and focal interstitial inflammatory infiltration mostly of lymphocytes and fibroblasts were detected; the amount of macrophages was not substantial. Considering cicatrical rebuilding of the anoderm of ulcer bottom caused, first of all, by hypoxia leading to activation of collagen-producing function of fibroblastes and absence of the signs of epithelization, patients with CAF should be treated surgically dissecting the bottom and margins of fissure in the complex with hypertrophic anal papilla and sentinel pile.

  16. Current concepts in anal fissures.

    PubMed

    Ayantunde, Abraham A; Debrah, Samuel A

    2006-12-01

    Anal fissure is a common and distressing problem the true incidence of which is probably higher than recorded. There is a progressive understanding of the etiopathogenesis of this entity and the changing trend in its management approach. This is a systematic review of available published literature looking at current management options in anal fissures. A MEDLINE-based search of the relevant literature from 1970 to 2004 was performed on the current concepts in etiopathogenesis and management of anal fissure. The current opinion is a drift toward conservative measures as the first- and second-line approaches rather than surgery for treatment of anal fissure. Simple and readily available measures with less complication, good patient compliance, and satisfaction requiring no hospitalization should first be considered. Most anal fissures heal with medical therapy, but their limitations include side effects, poor compliance, and recurrence of the fissure. A cautious surgical approach is required to treat those who do not respond to medical therapy.

  17. Open versus closed lateral internal anal sphincterotomy in the management of chronic anal fissures: a prospective randomized study.

    PubMed

    Gupta, Vivek; Rodrigues, Gabriel; Prabhu, Raghunath; Ravi, Chandni

    2014-10-01

    Chronic anal fissure is a benign disorder that is associated with considerable discomfort. Surgical treatment in the form of lateral sphincterotomy has long been regarded as the gold standard of treatment. This study compared the open and closed techniques of lateral sphincterotomy in terms of their postoperative outcomes. A prospective, randomized comparative study was conducted between October 2010 and August 2012. A total of 136 patients were randomly assigned to each of two groups. Patients were followed up postoperatively for more than 1 year to assess any complications. The outcomes were compared among the two groups using the Chi-square test and Student t test. The mean age at presentation was 40.13 years. The male to female ratio was 1.47:1. The typical presentation was painful defecation. Fissures were most often located in the posterior midline and associated with a sentinel pile. Delayed postoperative healing was found in 4.4% of the group of patients undergoing open lateral sphincterotomy. The mean pain score and duration of hospital stay were lower with the closed technique. Closed lateral internal sphincterotomy is the treatment of choice for chronic fissures as it is effective, safe, less expensive, and associated with a lower rate of complications than the open sphincterotomy technique. Copyright © 2014. Published by Elsevier B.V.

  18. Topical application of LEVORAG® as first-line treatment for chronic anal fissures: a preliminary multicentric study.

    PubMed

    Giordano, P; Mistrangelo, M; Cracco, N; D'Elia, A; Creperio, G; Digito, F; Paduano, R; Tapparo, A; Quinto, S; Villa, E; Pagano, C

    2015-10-01

    The aim of the present study was to assess the safety and efficacy of this new topical agent as a first line treatment in patients with chronic anal fissures. Nine centres were involved in the study. Patients with chronic anal fissures were recruited and received Levorag® for 40 days. Follow-up visits were conducted at 10, 20 and 40 days from the recruitment. Primary outcome was the healing rate, secondary outcome the reduction of pain at the end of the treatment measured with a VAS scale. Fifty patients completed the treatment. No adverse events were recorded. 60% of patients healed completely at the end of the treatment. In those that did not heal the reduction of mean VAS values was 60%. The use of Levorag® on patients affected by chronic anal fissures achieved in the short term results similar to those experienced by more classic local treatments without any side effect.

  19. Open lateral internal anal sphincterotomy under local anesthesia as the gold standard in the treatment of chronic anal fissures. A prospective clinical and manometric study.

    PubMed

    Sánchez Romero, A; Arroyo Sebastián, A; Pérez Vicente, F; Serrano Paz, P; Candela Polo, F; Tomás Gómez, A; Costa Navarro, D; Fernández Frías, A; Calpena Rico, R

    2004-12-01

    Chronic anal fissure is one of the most frequent proctological disorders in Western populations. Open lateral internal sphincterotomy is one of the therapeutic options accepted as the treatment of choice for chronic anal fissure, since it reduces the hypertonia of the internal anal sphincter (the main etiopathogenic mechanism of fissures), decreases anal pain, and allows the fissure to heal. We carried out a prospective study of 120 patients operated on for chronic anal fissure with open sphincterotomy under local anesthesia at our Proctology Outpatient Unit from 1998 to 2001. No preoperative studies, bowel preparation, or antibiotic prophylaxis were carried out. All patients were followed up after 1 week, 2 months, 6 months, and 1 year, and underwent an anal manometry before and after surgery. Early complications: 3 hematoma-ecchymosis of the wound (2.5%), 3 self-limited hemorrhage events (2.5%). No hemorrhoidal thrombosis, fistulas, or perianal abscesses occurred. Fissures recurred in nine patients (7.5%) within one year. The initial rate of incontinence of 7.5% at two months dropped down to 5% at six months. The mean resting pressure (MRP) in incontinent patients was lower than in continent patients (55 +/- 7 mmHg versus 80.7 +/- 21 mmHg). The difference in mean squeeze pressure (MSP) between incontinent patients and continent patients was not statistically significant. Open sphincterotomy under local anesthesia has a long-term rate of healing and a morbidity rate similar to other techniques. It may therefore be considered an effective treatment for chronic anal fissure.

  20. Botulinum toxin A injection in ISDN ointment-resistant chronic anal fissures.

    PubMed

    Witte, M E; Klaase, J M

    2007-01-01

    In the treatment of chronic anal fissures (CAFs), surgical sphincterotomy is more commonly being replaced by chemical sphincterotomy. After the good results of our pilot study including 32 patients, we now describe the effect of botulinum toxin A (BT-A) in a consecutive series of 100 patients with isosorbide dinitrate (ISDN) ointment-resistant CAFs. From October 2002 until August 2005, 100 patients (52 males, 48 females) with a median age of 45 (20-79) years were treated with an injection of 40-100 IU BT-A (Dysport, Ipsen, The Netherlands) in the internal anal sphincter. After a median follow-up of 10 (4-38) months, 77 of the 100 CAFs (77%) were cured. 20 patients were given a second injection, 1 a third and 1 a fourth injection. In 11 patients a fissure recurred (14%). In 1 patient (1%) there was temporary incontinence due to flatus. With an early response rate of 77% and an overall success rate of 66%, BT-A injections appear to be effective in patients with ISDN ointment-resistant CAFs if initial non-responders are retreated. These results are in concordance with the results of our pilot study. It is a simple technique with little or no side effects, that does not compromise future treatments. Its place in the first-line treatment of CAFs should be investigated further. Copyright (c) 2007 S. Karger AG, Basel.

  1. Botulinum toxin therapy for chronic anal fissures: where are we at currently?

    PubMed

    Dat, Anthony; Chin, Martin; Skinner, Stewart; Farmer, Chip; Wale, Roger; Carne, Peter; Bell, Stephen; Warrier, Satish K

    2017-09-01

    Botulinum toxin (Botox) injection for chronic anal fissure (CAF) is commonly performed, yet there remains no consensus on optimal dosage or frequency of injections required to achieve complete resolution of anal fissure. The aim of this study was to determine the effectiveness of Botox and side-effect profile in the management of CAF. A retrospective clinical study of patients between 2010 and 2014 who underwent a Botox injection for CAF at a tertiary centre was performed. The effectiveness of Botox was measured using standardized outcomes including overall healing rate, presence of anal pain, recurrence and need for repeat botulinum injection. Binary outcomes were assessed using logistic regression model. The analysis was performed using Stata version 13 (StataCorp, College Station, TX, USA). One hundred and one patients underwent 126 Botox injections within the study period. The mean first post-operative visit was at 1 month. The overall recurrence rate was 32%. The majority of patients were given 33 U. No statistically significant relationship between dose and recurrence was identified. The presence of pain at the first post-operative visit was a predictor of future recurrence (odds ratio 3.92, confidence interval 1.58-9.74, P = 0.003). Botox is an effective strategy for CAF. Low doses can be given with good efficacy as highlighted by our audit and has the potential for great cost saving. The best predictor of recurrence is the presence of pain at the first post-procedure visit. © 2015 Royal Australasian College of Surgeons.

  2. A novel method for treatment of chronic anal fissure: adipose-derived regenerative cells - a pilot study.

    PubMed

    Andjelkov, K; Sforza, M; Barisic, G; Soldatovic, I; Hiranyakas, A; Krivokapic, Z

    2017-06-01

    The purpose of this study was to investigate the safety and feasibility of autologous adipose-derived regenerative cells (ADRC) in the treatment of chronic anal fissure. A prospective pilot study was conducted in six patients with chronic anal fissures at the First Surgical Clinic, Clinical Center of Serbia and at the BelPrime Clinic, Belgrade, Serbia. All patients were candidates for surgical treatment. The average duration of symptoms was 24 months. Pain assessment was quantified using a visual analogue scale and bowel continence was assessed using the Wexner incontinence score. Both were assessed before treatment and during each postoperative outpatient visit. Liposuction was performed under local or general anaesthesia. Extraction of ADRC was achieved with a closed automated medical device. The fat and ADRC were injected subcutaneously into the edge of the fissure. The rest of the pellet was infiltrated into the internal anal sphincter. The study has been registered at ClinicalTrials.gov (NCT02628522). Complete healing of the anal fissure and the disappearance of symptoms was achieved in all patients. The average time to complete pain cessation was 33.7 ± 15.0 days. All fissures healed after 3 months and remained healed 12 months after the procedure. There were no complications related to the procedure. The application of ADRC may be an alternative to lateral sphincterotomy and a reliable procedure which avoids faecal incontinence. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  3. Effectiveness of higher doses of botulinum toxin to induce healing in patients with chronic anal fissures.

    PubMed

    Brisinda, Giuseppe; Maria, Giorgio; Sganga, Gabriele; Bentivoglio, Anna Rita; Albanese, Alberto; Castagneto, Marco

    2002-02-01

    Botulinum toxin induces healing in patients with idiopathic anal fissures. One hundred-fifty patients with posterior anal fissures were treated with botulinum toxin injected in the internal anal sphincter on each side of the anterior midline. Subjects were randomized into 2 treatment groups based on the number of units of botulinum toxin injected. Patients in group I were treated with 20 units of botulinum toxin and, if the fissure persisted, were retreated with 30 units. Patients in group II were treated with 30 units and retreated with 50 units, if the fissure persisted. The 2 groups were comparable in age, gender distribution, duration of symptoms, resting pressure, and maximum voluntary pressure at anorectal manometry. One month after the injection, examinations revealed complete healing in 55 patients (73%) from group I and 65 patients (87%) from group II (P =.04). Five patients from group II reported a mild incontinence of flatus that lasted 2 weeks after the treatment and disappeared spontaneously. The values of the resting anal pressure (P=.3) and the maximum voluntary pressure (P =.2) did not differ between the 2 groups. At 2 months' evaluation, a healing scar was found in 67 patients (89%) from group I and 72 patients (96%) from group II. A relapse of the fissure was observed in 6 patients (8%) from group I who had a healing scar at 1 month, and 2 other patients never healed. A persistent fissure was present in 3 patients from group II who had no other symptoms. Botulinum toxin injected into the internal anal sphincter is effective in managing anal fissures and avoiding permanent complications. All patients were treated with the active drug and healed after 1 or 2 successive treatments. The results also confirm that higher doses account for a higher success rate, with little increase in complications or side effects, which is probably related to the diffusion of the toxin to the external sphincter.

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

    PubMed

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

    2017-05-01

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

  5. Oligo-antigenic diet in the treatment of chronic anal fissures. Evidence for a relationship between food hypersensitivity and anal fissures.

    PubMed

    Carroccio, Antonio; Mansueto, Pasquale; Morfino, Giuditta; D'Alcamo, Alberto; Di Paola, Valentina; Iacono, Giuseppe; Soresi, Maurizio; Scerrino, Gregorio; Maresi, Emiliano; Gulotta, Gaspare; Rini, Giovambattista; Bonventre, Sebastiano

    2013-05-01

    Patients with chronic constipation due to food hypersensitivity (FH) had an elevated anal sphincter resting pressure. No studies have investigated a possible role of FH in anal fissures (AFs). We aimed to evaluate (1) the effectiveness of diet in curing AFs and to evaluate (2) the clinical effects of a double-blind placebo-controlled (DBPC) challenge, using cow's milk protein or wheat. One hundred and sixty-one patients with AFs were randomized to receive a "true-elimination diet" or a "sham-elimination diet" for 8 weeks; both groups also received topical nifedipine and lidocaine. Sixty patients who were cured with the "true-elimination diet" underwent DBPC challenge in which cow's milk and wheat were used. At the end of the study, 69% of the "true-diet group" and 45% of the "sham-diet group" showed complete healing of AFs (P<0.0002). Thirteen of the 60 patients had AF recurrence during the 2-week cow's milk DBPC challenge and 7 patients had AF recurrence on wheat challenge. At the end of the challenge, anal sphincter resting pressure significantly increased in the patients who showed AF reappearance (P<0.0001), compared with the baseline values. The patients who reacted to the challenges had a significantly higher number of eosinophils in the lamina propria and intraepithelial lymphocytes than those who did not react to the challenges. An oligo-antigenic diet combined with medical treatment improved the rate of chronic AF healing. In more than 20% of the patients receiving medical and dietary treatment, AFs recurred on DBPC food challenge.

  6. Lateral internal sphincterotomy versus 0.25 % isosorbide dinitrate ointment for chronic anal fissures: a prospective randomized controlled trial.

    PubMed

    Arslan, Kemal; Erenoğlu, Bülent; Doğru, Osman; Turan, Ersin; Eryilmaz, Mehmet Ali; Atay, Arif; Kökçam, Said

    2013-05-01

    To compare the healing properties of lateral internal sphincterotomy (LIS) and isosorbide dinitrate (ISDN) ointment for chronic anal fissure. Patients with a chronic anal fissure were randomly assigned to a group treated with ISDN ointment (n = 105) or a group treated with LIS (n = 102). The same investigators examined the patients in a blinded manner, 1, 2, 3, 6, and 12 months after the treatments. The anal fissure had healed completely by 4 weeks in 64.7 versus 92.2 %, and by 6 months in 77.1 versus 97.1 % of the ISDN and LIS group patients, respectively. At 12 months, the recurrence rates were 4.8 versus 1 % for the ISDN and LIS groups, respectively, and the success rates of the treatments were 72.4 versus 96.1 %, respectively. Six patients in the LIS group experienced minor fecal incontinence, and seven (6.7 %) patients in the ISDN group experienced headaches that responded well to paracetamol. ISDN ointment was reported by all patients to be easy to use. Although its success rate was lower than that of surgery, ISDN can be offered to selected patients with a chronic anal fissure, as it has a low recurrence rate and rare side effects are rare.

  7. Efficacy of management algorithm for reducing need for sphincterotomy in chronic anal fissures.

    PubMed

    Sinha, R; Kaiser, A M

    2012-06-01

    Lateral internal sphincterotomy is the most effective treatment for chronic anal fissure (CAF), but carries a risk of faecal incontinence. We aimed to analyse efficacy and acceptance of a treatment algorithm in reducing the rate of necessary sphincterotomies. Patients with CAF seen from 2001 to 2010 were retrospectively analysed. All patients were offered all steps of the algorithm nitroglycerine (NTG) → Botox (BTX) → surgery, unless symptoms or patient preference demanded a more aggressive treatment. Patients were followed up in clinic, and treatment was advanced if a step either failed or caused intolerable side effects. Two hundred and nine patients were included in the analysis. Mean duration of symptoms was 25.6 months and mean follow up 16 months. One hundred and 41 patients started on NTG, 36 on BTX, and 31 went straight to surgery. One patient opted for no treatment. Symptoms persisted in 58 (41.1%) of 141 NTG patients. Forty-five (31.9% of NTG subset) were advanced to BTX and 13 (9.2% of subset) to surgery. Of the 81 (36 primary + 45 secondary) BTX patients (38.8% of the total), only 11 (13.6% of subset) required surgery. A total of 55 (31 primary + 24 secondary; 26.3%) patients needed surgery: two (3.6%) fissures did not heal, one patient developed an abscess, 14 (25.5%) had prolonged wound healing and two (3.6%) developed a recurrent fissure after the sphincterotomy had healed. Our algorithm is effective in CAF and the majority of patients respond to conservative management. Only 26.3% of all patients require surgery, which is effective but also carries some temporary morbidity. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  8. Anorectal conditions: anal fissure and anorectal fistula.

    PubMed

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

    2014-04-01

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

  9. Comparative study of lateral internal sphincterotomy versus local 0.2% glyceryl trinitrate ointment for the treatment of chronic anal fissure.

    PubMed

    Siddique, Md Ibrahim; Murshed, Khandker Manzoor; Majid, M A

    2008-04-01

    The gold standard surgical treatment of chronic anal fissure is lateral internal sphincterotomy which lowers the resting anal pressure and effectively heals the majority of fissures. Local application of 0.2% glyceryl trinitrate ointment has been used as an agent for chemical sphincterotomy, causing temporary alleviation of sphincter spasm and allowing the fissure to heal without compromising the anal continence. The aim of the present study was to compare the results of surgical sphincterotomy with that of local 0.2% glyceryl trinitrate ointment in the treatment of chronic anal fissure. Seventy adult patients between the age of 18 and 50 years with chronic anal fissure were randomized in a prospective trial to receive either surgical sphincterotomy or 0.2% glyceryl trinitrate ointment locally. Patients were followed up at 2 weeks' interval for 10 weeks. Symptom relief, fissure healing and continence scores were the outcomes assessed. Six patients were excluded for protocol violations. Surgical sphincterotomy was significantly more effective in providing pain relief and was associated with significantly better fissure healing rates at 6 weeks and 10 weeks (both p < 0.001). There were substantial problems with compliance in ointment group related to slow healing and longer time needed for symptomatic relief. Minor incontinence was 6% in sphincterotomy group and none in ointment group (p > 0.05). Considering early symptomatic relief, rapid fissure healing and better patient compliance surgical sphincterotomy is the treatment of choice for chronic anal fissure.

  10. A study to determine the nitroglycerin ointment dose and dosing interval that best promote the healing of chronic anal fissures.

    PubMed

    Bailey, H Randolph; Beck, David E; Billingham, Richard P; Binderow, Sander R; Gottesman, Lester; Hull, Tracy L; Larach, Sergio W; Margolin, David A; Milsom, Jeffrey W; Potenti, Fabio M; Rafferty, Janice F; Riff, Dennis S; Sands, Lawrence R; Senagore, Anthony; Stamos, Michael J; Yee, Laurence F; Young-Fadok, Tonia M; Gibbons, Robert D

    2002-09-01

    The aim of this study was to determine the optimal dose and dosing interval of nitroglycerin ointment to heal chronic anal fissures. A randomized, double-blind study of intra-anally applied nitroglycerin ointment (Anogesic) was conducted in 17 centers in 304 patients with chronic anal fissures. The patients were randomly assigned to one of eight treatment regimens (0.0, 0.1, 0.2, 0.4 percent nitroglycerin ointment applied twice or three times per day), for up to eight weeks. A dose-measuring device standardized the delivery of 374 mg ointment. Healing of fissures (complete reepithelialization) was assessed by physical examination using an observer unaware of treatment allocation. The subjects assessed pain intensity daily by completing a diary containing a visual analog scale for average pain intensity for the day, the worst pain intensity for the day, and pain intensity at the last defecation. There were no significant differences in fissure healing among any of the treatment groups; all groups, including placebo had a healing rate of approximately 50 percent. This rate of placebo response was inexplicably higher than previously reported in the literature. Treatment with 0.4 percent (1.5 mg) nitroglycerin ointment was associated with a significant (P < 0.0002) decrease in average pain intensity compared with vehicle as assessed by patients with a visual analog scale. The decreases were observed by Day 4 of treatment. At 8 weeks the magnitude of the difference between 0.4 percent nitroglycerin and control was a 21 percent reduction in average pain. Treatment was well tolerated, with only 3.29 percent of patients discontinuing treatment because of headache. Headaches were the primary adverse event and were dose related. Nitroglycerin ointment did not alter healing but significantly and rapidly reduced the pain associated with chronic anal fissures.

  11. Outcome Of 0.2% Glyceryltrinitrate Cream Versus 2% Diltiazem Cream In The Treatment Of Chronic Anal Fissure.

    PubMed

    Khan, Muhammad Siddique; Akbar, Ismail; Zeb, Junaid; Ahmad, Salman; Khan, Ajmal

    2017-01-01

    Anal fissure is a linear tear in the distal anal canal resulting from persistent hypertonia and spasm of the internal sphincter which results in mucosal ischemia. We have conducted a study in order to compare the outcome of 0.2% glyceryl trinitrate cream versus 2% diltiazem cream in the treatment of chronic anal fissure. This randomized controlled trial (RCT) was carried out in the Department of Surgical "B" unit, at Ayub Teaching Hospital, Abbottabad, Pakistan from 15th June 2012 to 15th May 2015. One hundred and eighty-four patients who visited the outpatient department for the treatment of chronic anal fissure were included in the study. They were divided into two groups with 92 patients in each group. Patients in group "A" included those patients receiving topical glyceryl trinitrate and group "B" patients were those receiving topical diltiazem cream. Out of 184 patients 66.3% were males, 33.7% were females. Mean age of the patients was 43.84±7.976 and mean duration of symptoms was 10.55±2.524. Overall outcome in terms of healing was 71.2%, among which 80.4% were from diltiazem group while 62% in glyceryl trinitrate group. Complete relief of pain was observed in 67.9%, 26.1% complained of mild pain and 5.4% complained of moderate pain. Only one patient in glyceryl trinitrate group complained with severe pain with no healing after one month of follow up. No statistical association was found between healing outcome and gender as well as age of the patients (p>0.05) although an association was found between healing outcome and duration of symptoms (p<0.05). This study shows that diltiazem has better outcome in terms of healing of chronic anal fissure and reductions in symptoms, i.e., pain compared with glyceryl trinitrate.

  12. Are we following an algorithm for managing chronic anal fissure? A completed audit cycle☆

    PubMed Central

    Farkas, Nicholas; Solanki, Kohmal; Frampton, Adam E.; Black, John; Gupta, Ashish; West, Nicholas J.

    2015-01-01

    Background Anal fissure is one of the commonest proctological diseases with considerable national variation in sequential treatment. We aimed to audit our compliance of chronic anal fissure (CAF) management with national guidance provided by the Association of Coloproctology of Great Britain and Ireland (ACPGBI). Methods We retrospectively audited patients presenting to outpatient clinics with CAF over a 6-month period. Using electronic patient records, notes and clinic letters, we compared their management with ACPGBI algorithm. A prospective re-audit was then performed. Results Forty-one patients were included in the analysis (59% male). Sixty-eight percent (n = 28/41) of patients were appropriately started on conservative dietary therapy, of whom only 7.1% (n = 2/28) had treatment success. Eighty-nine percent (n = 25/28) were then appropriately treated with either topical diltiazem 2% or GTN 0.4%. Overall, 43.9% (n = 18/41) of all patients' entire management strategy adhered to the ACPGBI guidelines. In total, 48.8% (n = 20/41) patients had surgical treatment (excluding Botox), of which only 15% (n = 3/20) had undergone ACPGBI-compliant management. After local dissemination of results and education, the re-audit of 20 patients showed significant improvement in adherence to the guidelines (43.9% vs. 95%; P = 0.0001). Conclusions Topical creams were the most successful treatments (50%; n = 9/18) in ACPGBI-compliant strategies. Importantly, these data suggests that compliance with the ACPGBI algorithm leads to healing without surgery in 83.3% (n = 15/18) of patients, compared to 26.1% (n = 6/23) with non-compliant methods (P = 0.0004). This highlights the benefit of early conservative and medical management of CAF, before attempting surgery. PMID:26858833

  13. 'Frozen finger' in anal fissures.

    PubMed

    Chintamani; Tandon, Megha; Khandelwal, Rohan

    2009-10-01

    Acute anal fissures are usually managed by various invasive and non-invasive modalities ranging from simple lifestyle changes to chemical and surgical sphincterotomies. Frozen finger, prepared using a water-filled ordinary rubber glove, was successfully used in one hundred patients, thus providing a cost-effective and simple solution to the problem.

  14. Aggressive treatment of acute anal fissure with 0.5% nifedipine ointment prevents its evolution to chronicity

    PubMed Central

    Katsinelos, Panagiotis; Kountouras, Jannis; Paroutoglou, George; Beltsis, Athanasios; Chatzimavroudis, Grigoris; Zavos, Christos; Katsinelos, Taxiarchis; Papaziogas, Basilis

    2006-01-01

    AIM: To investigate the efficacy of topical application of 0.5% nifedipine ointment in healing acute anal fissue and preventing its progress to chronicity. METHODS: Thirty-one patients (10 males, 21 females) with acute anal fissure from September 1999 to January 2005 were treated topically with 0.5% nifedipine ointment (t.i.d.) for 8 wk. The patients were encouraged to follow a high-fiber diet and assessed at 2, 4 and 8 wk post-treatment. The healing of fissure and any side effects were recorded. The patients were subsequently followed up in the outpatient clinic for one year and contacted by phone every three months thereafter, while they were encouraged to come back if symptoms recurred. RESULTS: Twenty-seven of the 31 patients completed the 8-wk treatment course, of them 23 (85.2%) achieved a complete remission indicated by resolution of symptoms and healing of fissure. Of the remaining four unhealed patients (14.8%), 2 opted to undergo lateral sphincterotomy and the other 2 to continue therapy for four additional weeks, resulting in healing of fissure. All the 25 patients with complete remission had a mean follow-up of 22.9 ± 14 (range 6-52) mo. Recurrence of symptoms occurred in four of these 25 patients (16%) who were successfully treated with an additional 4-wk course of 0.5% nifedipine ointment. Two of the 27 (7.4%) patients who completed the 8-wk treatment presented with moderate headache as a side effect of nifedipine. CONCLUSION: Topical 0.5% nifedipine ointment, used as an agent in chemical sphincterotomy, appears to offer a significant healing rate for acute anal fissure and might prevent its evolution to chronicity. PMID:17036396

  15. Optimal Dosing of Botulinum Toxin for Treatment of Chronic Anal Fissure: A Systematic Review and Meta-Analysis.

    PubMed

    Lin, Jin Xin; Krishna, Sanjeev; Su'a, Bruce; Hill, Andrew G

    2016-09-01

    Chronic anal fissures are associated with significant morbidity and reduced quality of life. Studies have investigated the efficacy of botulinum toxin with variable results; thus, there is currently no consensus on botulinum toxin dose or injection sites. This study aimed to systematically analyze trials studying the efficacy of botulinum toxin for treatment of chronic anal fissure to identify an optimum dosage and injection regimen. A comprehensive review of the literature was conducted according to PRISMA guidelines. PubMed/Medline, Embase, Scopus, and the Cochrane Library were searched from inception to June 2015. All clinical trials that investigated the efficacy of botulinum toxin for chronic anal fissure were selected according to specific criteria. The interventions used were various doses of botulinum toxin. Clinical outcomes, dosage, and injection site data were evaluated with weighted pooled results for each dosage and 95% confidence intervals. There were 1158 patients, with 661 in botulinum toxin treatment arms, from 18 clinical trials included in this review. The outcomes of interest were 3-month healing, incontinence, and recurrence rates. Meta-regression analysis demonstrated a small decrease in healing rate (0.34%; 95% CI, 0-0.68; p = 0.048) with each increase in dosage, a small increase in incontinence rate (1.02 times; 95% CI, 1.0002-1.049; p = 0.048) with each increase in dosage and a small increase in recurrence rate (1.037 times; 95% CI, 1.018-1.057; p = 0.0002) with each increase in dosage. The optimum injection site could not be determined. This study was limited by weaknesses in the underlying evidence, such as variable quality, short follow-up, and a limited range of doses represented. Fissure healing with lower doses of botulinum toxin is as effective as with high doses. Lower doses also reduce the risk of incontinence and recurrence in the long term.

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

    PubMed

    Salih, Abdulwahid M

    2017-03-01

    Anal fissure are defined as a tear in the skin of the anal canal distal to dentate line. Although still there are controversies about the exact management, lateral sphincterotomy is promising. The aim of this series is to present the outcome of lateral sphincterotomy for internal anal sphincter in term of patient satisfaction and complication. A prospective single cohort study, 190 patients, who were undergone lateral sphincterotomy for internal anal sphincter from 2010 to 2014, were analyzed. The operation was performed as a day case procedure. The median duration of follow up was 5 years (ranging from 3 to 6). The data were analyzed using the Statistical Package for Social sciences (SPSS) version 22. Descriptive statistic was used to describe findings. Forty three males (22.6%) and 147 females (77.4%) with a mean ± SD of age of 31.19 ± 7.78 years. Constipation was reported in 152 (80%) patients, bleeding in 131 (68.6%) cases, and pain in 142 (74.7%) patients. The median duration of the disease was 20 months (ranging from 1 to 30 months). Post-operatively, patient satisfaction was high (98.4%) with only 3 cases (1.6%) of recurrence. Conclusion: lateral sphincterotomy for internal anal sphincter, along, is the procedure of choice for management of CAF because it is effective and it can cure the disease in nearly all patients with good patient satisfaction.

  17. Comparative study of Ksharasutra suturing and Lord's anal dilatation in the management of Parikartika (chronic fissure-in-ano)

    PubMed Central

    Dudhamal, Tukaram S.; Baghel, Madhav Singh; Bhuyan, Chaturbhuja; Gupta, Sanjay Kumar

    2014-01-01

    Background: Parikartika resembles fissure-in-ano which is very common among all ano-rectal disorders. In Ayurvedic texts, Parikartika is described as a complication of Vamana and Virechana as well as complication of Atisara. Ksharasutra was proved successful in the management of fistula-in-ano, piles, and there is a need to try its efficacy in fissure-in-ano. Aim: To evaluate the role of Ksharasutra suturing (KSS) in fissure bed in chronic fissure-in-ano. Materials and Methods: Total 100 patients of chronic fissure-in-ano were selected and randomly divided into two groups (50 in each group). In group-A, patients were undergone by KSS; while in patients of Group-B Lord's anal dilatation followed by KSS was done under spinal anesthesia. The KSS was done once and after slough out of Ksharasutra, the wound was treated for 4 weeks and assessment of the result was done on the basis of gradation adopted. Results: The pain relief on 14th day in Group-A was 86% while in Group-B 100% was observed. As on 7th day in Group-A, oozing was stopped in 68% patients, while in Group-B, oozing was stopped in 82% patients. On 21st day, Group-B showed more healing (85%) as compared to Group-A (69%). In this study 68% of patients were cured. Conclusion: In Group-B (KSS with Lord's anal dilatation) patients were cured early as compared to patients of Group-A (KSS alone). PMID:25558158

  18. [Favourable results with local injections of botulinum-A toxin in patients with chronic isosorbide dinitrate ointment-resistant anal fissures].

    PubMed

    Witte, M E; Klaase, J M

    2006-07-08

    To determine the effectiveness of injection of botulinum-A toxin in the internal anal sphincter as a treatment for chronic therapy-resistant anal fissures. Prospective. In the period October 2002-February 2005, 32 consecutive patients (15 men and 17 women), with a median age of 44 years (range: 23-78 years) and suffering from chronic isosorbide dinitrate ointment-resistant anal fissures, were treated with an injection of 40 IU botulinum-A toxin (Dysport, Ipsen, The Netherlands) in the ventral side of the internal anal sphincter. The injection was given as an outpatient procedure under general or spinal anaesthesia. After a median follow-up of 14 months (range: 2-28 months), the chronic anal fissures were cured in 24 ofthe 32 patients (75%). Twenty-two patients were given a second or a third injection. A fissure recurred in one of the cured patients (4%), and one patient suffered from temporary flatus incontinence. Botulinum-A toxin injections were effective in 75% of patients with isosorbide dinitrate ointment-resistant chronic anal fissures. This is a simple technique with fewer side effects than local application of NO donors and fewer complications and less morbidity than surgical sphincterotomy.

  19. Long-term outcomes of Botulinum toxin in the treatment of chronic anal fissure: 5 years of follow-up.

    PubMed

    Barbeiro, Sandra; Atalaia-Martins, Catarina; Marcos, Pedro; Gonçalves, Cláudia; Canhoto, Manuela; Arroja, Bruno; Silva, Filipe; Cotrim, Isabel; Eliseu, Liliana; Santos, Antonieta; Vasconcelos, Helena

    2017-03-01

    Chronic anal fissure is a frequent and disabling disease, often affecting young adults. Botulinum toxin and lateral internal sphincterotomy are the main therapeutic options for refractory cases. Botulinum toxin is minimally invasive and safer compared with surgery, which carries a difficult post-operative recovery and fecal incontinence risk. The long-term efficacy of Botulinum toxin is not well known. The aim of this study was to evaluate the long-term efficacy and safety of Botulinum toxin in the treatment of chronic anal fissure. This was a retrospective study at a single center, including patients treated with Botulinum toxin from 2005 to 2010, followed over at least a period of 5 years. All patients were treated with injection of 25U of Botulinum toxin in the intersphincteric groove. The response was registered as complete, partial, refractory and relapse. Botulinum toxin was administered to 126 patients, 69.8% (n = 88) were followed over a period of 5 years. After 3 months, 46.6% (n = 41) had complete response, 23.9% (n = 21) had partial response and 29.5% (n = 26) were refractory. Relapse was observed in 1.2% (n = 1) at 6 months, 11.4% (n = 10) at 1 year, 2.3% (n = 2) at 3 years; no relapse at 5 years. The overall success rate was 64.8% at 5 years of follow-up. Botulinum toxin was well tolerated by all patients and there were no complications. The use of Botulinum toxin to treat patients with chronic anal fissure was safe and effective in long-term follow-up.

  20. Operative and medical treatment of chronic anal fissures-a review and network meta-analysis of randomized controlled trials.

    PubMed

    Ebinger, Sabrina Maria; Hardt, Julia; Warschkow, René; Schmied, Bruno Martin; Herold, Alexander; Post, Stefan; Marti, Lukas

    2017-06-01

    Anal fissures are a common problem and have a cumulative lifetime incidence of 11%. Previous reviews on anal fissures show inconsistent results regarding post-interventional healing and incontinence rates. In this review our aim was to compare the treatments for chronic anal fissures by incorporating indirect comparisons using network meta-analysis. The PubMed database was searched for randomized controlled trials (RCTs) published between 1975 and 2015. The primary outcome measures were healing and incontinence rates after lateral internal sphincterotomy (LIS), anal dilatation (DILA), anoplasty and/or fissurectomy (FIAP), botulinum toxin (BT) and noninvasive treatment (NIT). Random effects network meta-analyses were complemented by fixed effects and Bayesian models. The present analysis included 44 RCTs and 3268 patients. After a median follow-up of 2 months, the healing rates for LIS, DILA, FIAP, BT and NIT were 93.1, 84.4, 79.8, 62.6, and 58.6% and the incontinence rates were 9.4, 18.2, 4.9, 4.1, and 3.0%, respectively. Compared with NIT, the odds ratio (OR) [95% confidence interval (CI)] for healing after LIS, DILA, FIAP and BT was 9.9 (5.4-18.1), 8.6 (3.1-24.0), 3.5 (1.0-12.7) and 1.9 (1.1-3.5), respectively, on network meta-analysis. The OR (95% CI) for incontinence after LIS, DILA, FIAP and BT was 6.8 (3.1-15.1), 16.9 (6.0-47.8), 3.9 (1.0-15.1) and 1.6 (0.7-3.7), respectively. Ranking of treatments, fixed effects and Bayesian models confirmed these findings. In conclusion, based on our meta-analysis LIS is the most efficacious treatment but is compromised by a high rate of postoperative incontinence. Given the trade-offs between the risks and benefits, FIAP and BT might be good alternatives for the treatment of chronic anal fissures.

  1. Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: a prospective, randomized study.

    PubMed

    Yucel, Tayfun; Gonullu, Dogan; Oncu, Mahmut; Koksoy, Ferda Nihat; Ozkan, Sibel Gurdal; Aycan, Omer

    2009-06-01

    The results of controlled-intermittent anal dilatation (CIAD) or lateral internal sphincterotomy (LIS) in the treatment of chronic anal fissures are presented. Forty patients who were randomized to two groups underwent CIAD or a LIS. The pre- and post-operative mean anal canal resting pressures (MACRPs) and symptoms were recorded and the results were compared. Two months post-operatively, 18 patients in the CIAD group and 17 patients in the LIS group had healed completely, and had no anal incontinence or other complications. The post-operative improvement in pain, bleeding, and constipation did not differ significantly between the two groups. In the CIAD and LIS groups, the pre-operative MACRPs were 89.7+/-16.5 and 87.6+/-12.3 mmHg, respectively; 2 months post-operatively, the MACRPs had significantly decreased to 76.9+/-13.7 and 78.1+/-11.3 mmHg in the CIAD and LIS groups, respectively. No statistical difference existed in the pre- or post-treatment MACRPs between the groups. CIAD applied with a standardized technique reduced anal canal resting pressure and provided symptomatic healing that was equivalent to a LIS. Since there were no findings of incontinence, or situations which resulted in sphincter damage, we conclude that CIAD is suitable for patients with chronic anal fissures because it is less invasive than LIS, with equivalent efficacy and safety. In addition, the CIAD method may be an alternative procedure in older and multiparous women who has a higher risk of incontinence.

  2. Anterior levatorplasty for the treatment of chronic anal fissures in females with a rectocele: a randomized, controlled trial.

    PubMed

    Ellis, C Neal

    2004-07-01

    It is postulated that an anterior anal fissure can result from mucosal trauma occurring during distention of a rectocele and that repair of the rectocele by anterior levatorplasty can lead to healing of these anal fissures. This study was designed to compare anterior levatorplasty with internal sphincterotomy for the management of anterior anal fissures in females with a rectocele. From June 2000 until May 2002, 54 consecutive females with an anterior anal fissure and a rectocele were randomized to be managed by internal sphincterotomy or anterior levatorplasty. Preoperatively, manometry was performed, continence was measured using the Cleveland Clinic scoring system, pain scores were obtained using a visual analog scale, and the symptoms of bleeding and straining to defecate were assessed. Postoperatively, pain scores were obtained at Days 2, 7, and 21. Manometry, continence scores, and resolution of symptoms were measured between 8 and 12 weeks. Patient satisfaction and fissure healing also were assessed between 8 and 12 weeks. The average length of follow-up was 20 (range, 6-30) months. Postoperatively, lateral sphincterotomy caused a decrease in the resting pressures and anterior levatorplasty resulted in an increased length of the anal canal. Anterior levatorplasty also caused increased postoperative pain scores. There were no differences in fissure healing and patient satisfaction. These data suggest that anterior levatorplasty is an option for the management of patients with a rectocele, which may avoid the risk of incontinence with lateral internal sphincterotomy and better address the etiology of anterior anal fissures.

  3. A dose finding study with 0.1%, 0.2%, and 0.4% glyceryl trinitrate ointment in patients with chronic anal fissures.

    PubMed

    Scholefield, J H; Bock, J U; Marla, B; Richter, H J; Athanasiadis, S; Pröls, M; Herold, A

    2003-02-01

    Anal fissure is a common painful condition affecting the anal canal. The majority of acute fissures heal spontaneously. However, some of these acute fissures do not resolve but become chronic. Chronic anal fissures were traditionally treated by anal dilation or by lateral sphincterotomy. However, both of these surgical treatments may cause a degree of incontinence in up to 30% of patients. Several recent trials have shown that nitric oxide donors such as glyceryl trinitrate (GTN) can reduce sphincter pressure and heal up to 70% of chronic fissures. This study addressed the dose-response to three different concentrations of GTN ointment compared with placebo in a double blind randomised controlled trial. A double blind, multicentre, randomised controlled trial was set up to compare placebo ointment against three active treatment arms (0.1%, 0.2%, and 0.4% GTN ointment applied at a dose of 220 mg twice daily) in chronic anal fissures. The primary end point was complete healing of the fissure. Two hundred patients were recruited over an eight month period from 18 centres. After eight weeks of treatment the healing rate in the placebo group was 37.5% compared with 46.9% for 0.1%, 40.4% for 0.2%, and 54.1% for 0.4% GTN. None was significantly better than the placebo response. A secondary analysis excluded fissures without secondary criteria for chronicity. Healing rates were then found to be 24% in the placebo group compared with 50% in the 0.1% GTN group, 36% in the 0.2% group, and 57% in the 0.4% GTN group. These values were statistically significantly different for the placebo group compared with 0.1% GTN, 0.4% GTN, and for the GTN treated group as a whole. The results of this study have demonstrated the significant benefit of topical GTN when applied to patients suffering from chronic anal fissures but acute fissures showed a tendency to resolve spontaneously. The high proportion of fissures which healed in the placebo group suggests that the definition of

  4. A dose finding study with 0.1%, 0.2%, and 0.4% glyceryl trinitrate ointment in patients with chronic anal fissures

    PubMed Central

    Scholefield, J H; Bock, J U; Marla, B; Richter, H J; Athanasiadis, S; Pröls, M; Herold, A

    2003-01-01

    Background: Anal fissure is a common painful condition affecting the anal canal. The majority of acute fissures heal spontaneously. However, some of these acute fissures do not resolve but become chronic. Chronic anal fissures were traditionally treated by anal dilation or by lateral sphincterotomy. However, both of these surgical treatments may cause a degree of incontinence in up to 30% of patients. Several recent trials have shown that nitric oxide donors such as glyceryl trinitrate (GTN) can reduce sphincter pressure and heal up to 70% of chronic fissures. Aim: This study addressed the dose-response to three different concentrations of GTN ointment compared with placebo in a double blind randomised controlled trial. Method: A double blind, multicentre, randomised controlled trial was set up to compare placebo ointment against three active treatment arms (0.1%, 0.2%, and 0.4% GTN ointment applied at a dose of 220 mg twice daily) in chronic anal fissures. The primary end point was complete healing of the fissure. Results: Two hundred patients were recruited over an eight month period from 18 centres. After eight weeks of treatment the healing rate in the placebo group was 37.5% compared with 46.9% for 0.1%, 40.4% for 0.2%, and 54.1% for 0.4% GTN. None was significantly better than the placebo response. A secondary analysis excluded fissures without secondary criteria for chronicity. Healing rates were then found to be 24% in the placebo group compared with 50% in the 0.1% GTN group, 36% in the 0.2% group, and 57% in the 0.4% GTN group. These values were statistically significantly different for the placebo group compared with 0.1% GTN, 0.4% GTN, and for the GTN treated group as a whole. Conclusions: The results of this study have demonstrated the significant benefit of topical GTN when applied to patients suffering from chronic anal fissures but acute fissures showed a tendency to resolve spontaneously. The high proportion of fissures which healed in the placebo

  5. Partial lateral internal sphincterotomy versus combined botulinum toxin A injection and topical diltiazem in the treatment of chronic anal fissure: a randomized clinical trial.

    PubMed

    Gandomkar, Hossein; Zeinoddini, Atefeh; Heidari, Reza; Amoli, Hadi Ahmadi

    2015-02-01

    The aim of this study is to evaluate the effectiveness and complications associated with combined topical diltiazem cream and botulinum toxin A injection versus partial lateral internal sphincterotomy in chronic anal fissure. This study is a parallel, randomized controlled trial (using the block randomization method). This study was performed at a university hospital in Iran. Ninety-nine patients who had chronic anal fissures were included. A total of 99 patients were randomly assigned to 2 groups; the first group received combined topical diltiazem ointment (for 6 weeks) and botulinum toxin A injection (once) (n = 49), and the second group received partial lateral internal sphincterotomy (n = 50). All the patients were followed up for 1 year. The primary outcomes measured were the healing of the anal fissure and the development of incontinence as the major adverse event during the 1-year follow-up period. The overall healing rate was 65% and 94% in the botulinum toxin A-diltiazem and partial lateral internal sphincterotomy groups (p < 0.001). The patients in the partial lateral internal sphincterotomy group experienced significantly higher incontinence scores (p = 0.04) according to the Cleveland Clinic Florida-Fecal Incontinence scoring system. In patients who had chronic anal fissure for ≤12 months, no statistical difference was observed in the healing rate between the botulinum toxin A-diltiazem and partial lateral internal sphincterotomy groups (100% vs 100%). However, in the patients with longer chronic fissures, the healing rate was significantly higher in the partial lateral internal sphincterotomy group (86% [18/21] vs 23% [5/21], p < 0.001). The 1-year follow-up period, subjective definitions of itching, and lack of anorectal manometry examinations and data regarding the effect of each treatment on anal sphincter pressure at rest and contraction are the key limitations of this study. Combined botulinum toxin A injection with a topical application of

  6. Fissurectomy Combined with High-Dose Botulinum Toxin Is a Safe and Effective Treatment for Chronic Anal Fissure and a Promising Alternative to Surgical Sphincterotomy.

    PubMed

    Barnes, Thomas G; Zafrani, Zakhi; Abdelrazeq, Ayman S

    2015-10-01

    There is paucity of data on the long-term outcome of the combination of fissurectomy and botulinum toxin A injection for the management of chronic anal fissure. The aim of this study is to assess the safety, efficacy, and long-term outcome of the combination of fissurectomy and botulinum toxin A injection. This is a nonrandomized prospective cohort study. This study was conducted at a district general hospital in the United Kingdom. The cohort included all patients treated with fissurectomy and botulinum toxin A for chronic anal fissure between September 2008 and March 2012. The patients were treated with a combination of fissurectomy and botulinum toxin A injection. Symptomatic relief, fissure healing, complications, recurrence, and the need for further surgical intervention. One hundred and two patients received fissurectomy and botulinum toxin A injection for chronic anal fissure. At 12-week follow-up, 68 patients had resolution of symptoms and complete healing of chronic anal fissure, 29 patients had improvement of symptoms but incomplete healing and had further topical or botulinum toxin A treatment with subsequent complete healing. Ninety-five patients (93%) reported no postoperative complications. Seven patients reported a degree of incontinence in the immediate postoperative period. All reported normal continence at12-week follow-up. No local complications were observed or reported. At the mean follow-up of 33 months, there was no evidence of recurrence. Twelve-month follow-up was conducted via telephone interview only. This study is nonrandomized and did not examine the dose response of Botulinum Toxin A. Fissurectomy combined with high-dose botulinum toxin A is a safe, effective, and durable option for the management of chronic anal fissure and a promising alternative to surgical sphincterotomy.

  7. A contraction response of the internal anal sphincter to Botulinum toxin: does low-pressure chronic anal fissure have a different pathophysiology?

    PubMed

    Lindsey, I; Jones, O M; Cunningham, C

    2011-09-01

    A subset of low-pressure fissures is not associated with typical internal anal sphincter hypertonia and may involve a different pathophysiological mechanism. We aimed to assess the manometric response of the internal anal sphincter to botulinum toxin in low-pressure fissures compared to high-pressure fissures. Twenty five units of botulinum toxin (Botox(TM)) were injected directly into the internal anal sphincter. Maximum resting pressure (MRP) and maximum squeeze increment (MSI) were documented at baseline and four weeks after injection. Nine (31%) of 29 patients had a low-pressure fissure. Those with an anterior fissure had a significantly lower median baseline MRP than those with a posterior fissure (66 vs 83 mmHg, P = 0.009). Significantly more patients with low-pressure fissures developed a contraction or no response (78%vs 30%, difference 48%, 95% CI 14-82%, P = 0.006). Those developing a contraction response had a lower mean baseline MRP than those developing a relaxation response (56 vs 86 mmHg, difference 30 mmHg, 95% CI 17-43%, P < 0.001). Botulinum toxin appears to have an atypical contraction effect on the internal anal sphincter in low-pressure (usually anterior) fissures. This may be accounted for by blockade of acetylcholine released at parasympathetic nerve terminals and the sympathetic ganglion (relaxation). Low pressure fissures may be physiologically different from high-pressure fissures. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  8. [Treatment of anal fissures with botulinum toxin].

    PubMed

    Wollina, U

    2008-04-01

    Chronic anal fissure is a common proctological disease. Botulinum toxin (BTX) can be used for temporary chemical denervation. The administration is by intramuscular injections into either the external or the internal anal sphincter muscles. The mode of action, administration techniques and possible complications or adverse effects of BTX therapy are discussed. The healing rate is dependent on the BTX dosage. The short-term healing rate (< or = 6 months) is between 60 and 90 %. In long-term follow-up studies (> 1 year), about 50 % of patients show a complete response. Adverse effects are generally mild but relapses occur more often compared to surgery. Conservative therapies including BTX are currently considered mostly as the first-line treatment. Among the surgical procedures, lateral sphincterotomy is the most effective treatment but shows higher incontinence and general morbidity rates than BTX.

  9. Percutaneous Posterior Tibial Nerve Stimulation vs Perianal Application of Glyceryl Trinitrate Ointment in the Treatment of Chronic Anal Fissure: A Randomized Clinical Trial.

    PubMed

    Ruiz-Tovar, Jaime; Llavero, Carolina

    2017-01-01

    Current therapeutic guidelines for the treatment of chronic anal fissure establish a medical approach as the first step. Glyceryl trinitrate ointment is the most popular of the available topical treatments in Spain but it is associated with the appearance of headache. The purpose of this study was to compare the compliance rate among patients receiving glyceryl trinitrate treatment for chronic anal fissure with that among patients receiving percutaneous posterior tibial nerve stimulation. This was a prospective randomized study. The study was conducted at Garcilaso Clinic (Madrid, Spain). Subjects with persistent anal fissure despite hygiene and dietary measures applied over at least a 6-week period were included. Study interventions were perianal application of glyceryl trinitrate ointment (twice daily for 8 weeks) and percutaneous posterior tibial nerve stimulation (30-minute session 2 days per week for 8 weeks). Compliance with the treatment and healing rate of chronic anal fissure in patients receiving glyceryl trinitrate ointment or undergoing percutaneous posterior tibial nerve stimulation were evaluated. Forty patients were included in each group. In the glyceryl trinitrate ointment group, 15% of the patients discontinued treatment because of disabling headaches. There were no adverse effects or treatment withdrawals in the percutaneous posterior tibial nerve stimulation group (p = 0.033). After 8 weeks of treatment, the healing rate in the percutaneous posterior tibial nerve stimulation group was 87.5% vs 65.0% in the glyceryl trinitrate ointment group (p = 0.018). Because the patients were not blinded to the treatment, we cannot rule out a placebo effect derived from the needle insertion in the percutaneous posterior tibial nerve stimulation group. Percutaneous posterior tibial nerve stimulation is a safe and effective alternative that is in some ways superior to glyceryl trinitrate ointment for the treatment of chronic anal fissure.

  10. Myoxinol (Hydrolyzed Hibiscus esculentus Extract) in the Cure of Chronic Anal Fissure: Early Clinical and Functional Outcomes

    PubMed Central

    Renzi, Adolfo; Di Sarno, Giandomenico; D'Aniello, Francesco; Ziccardi, Stefania; Paladino, Fiorella

    2015-01-01

    Objective. This study was designed to evaluate the early results of the topical application of Hydrolyzed Hibiscus esculentus Extract 3% ointment (Myoxinol 3%), a novel local product with Botox-like activity, in the conservative treatment of chronic anal fissure (CAF). Methods. Among all patients with CAF observed during the study period, 31 subjects met the inclusion criteria and underwent medical therapy with Myoxinol 3% ointment every 12 hours for 6 weeks. Two patients were lost to follow-up. Clinical and manometric follow-up was carried out eight weeks after treatment. Results. At follow-up the success rate was 72.4% (21/29); median VAS score and mean anal resting pressure were significantly lower if compared with respective baseline data. The only one adverse effect of the topical application of Myoxinol 3% ointment was perianal itch, which was reported by 3,4% (1/29) of the patients available for the analysis. However, in this case this symptom did not cause interruption of the treatment. Conclusions. The topical application of Myoxinol 3% ointment in the cure of CAF shows encouraging early results. Further researches with a larger series and a longer follow-up are needed to confirm these data. PMID:25861259

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

    PubMed Central

    Gupta, Pravin J.

    2004-01-01

    AIM: Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. They are mostly ignored being considered as normal structures. The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus. METHODS: Two groups of patients were studied. A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of a hundred patients who also had papillae or fibrous polyps, were treated by lateral sphincterotomy alone. They were followed up for one year. RESULTS: Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated. Group A patients showed a marked reduction with regard to pain and irritation during defecation (P = 0.0011), pricking or foreign body sensation in the anus (P = 0.0006) and pruritus or wetness around the anal verge (P = 0.0008). CONCLUSION: Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure. This would add to effectiveness and completeness of the procedure. PMID:15285031

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

    PubMed

    Gupta, Pravin-J

    2004-08-15

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

  13. Botulinum toxin A in anal fissures: a modified technique.

    PubMed

    Wollina, U; Konrad, H

    2002-09-01

    Anal fissures are common and painful. Botulinum toxin A (BTXA) is considered to be the most potent non-surgical treatment; however, no attention has been paid to associated hyperhidrosis. To compare traditional BTXA treatment of muscular spasticity in anal fissures with combined treatment of spasticity and focal hyperhidrosis of the anal fold and perianal skin. Outpatient department of a dermatological hospital. Ten patients with chronic anal fissures (of more than 6 months duration who failed to respond to conservative treatment and who had refused surgery) associated with focal hyperhidrosis as assessed by Minor's sweat test were investigated in an open, two-armed trial. Intramuscular injections of 20-25 U BTXA (Botox) were performed in group A (n = 5). In group B (n = 5) those injections were combined with intracutaneous injection of 30-50 U BTXA to treat focal hyperhidrosis. Mean follow-up was 5 months. Five of five patients in group B but only two of five patients in group A experienced a complete remission despite the fact that relief of pain was evident in eight of 10 patients within 2 weeks. Patient satisfaction with treatment was high but slightly better in group B. This open trial suggests that combined therapy of both muscular spasticity and focal hyperhidrosis may provide better results than intramuscular injections alone in anal fissure therapy with BTXA.

  14. Anterior anal fissures are associated with occult sphincter injury and abnormal sphincter function.

    PubMed

    Jenkins, J T; Urie, A; Molloy, R G

    2008-03-01

    The pathogenesis of chronic anal fissure (CAF) remains incompletely understood but most are associated with a high resting anal pressure and reduced perfusion at the fissure site. To date, no major distinction has been made between anterior and posterior anal fissures and their aetiology and treatment. We compared anterior and posterior fissures in patients who have failed to respond to medical treatment with respect to their underlying aetiology, anal canal pressures and sphincter muscle integrity. Seventy consecutive patients (54 female:16 male) with a symptomatic CAF and 39 normal controls (19 female:20 male) without evidence of significant ano-rectal pathology were prospectively assessed by manometry and anal endosonography. Anterior anal fissures were identified in a younger age group [33 years (IQR 26-37) vs 41 years (IQR 36-52)] and predominantly in women. Anterior fissure patients were significantly more likely to have underlying external anal sphincter defects compared with posterior fissures [OR 10.9 (95% CI 3.4-35.4)]. Maximum resting pressure was not significantly elevated for anterior fissures compared with controls (P = 0.316) but was significantly elevated in posterior fissures (P = 0.005). The maximum squeeze pressure was significantly lower in the anterior fissure group [167 cmH2O (IQR 126-196) vs 205 cmH2O (IQR 174-262), P = 0.004]. A history of obstetric trauma was significantly associated with anterior fissure location [OR 13.9 (95% CI 3.4-55.7)]. Anterior anal fissures are associated with occult external anal sphincter injury and impaired external anal sphincter function compared with posterior fissures. These findings have implications for treatment, especially if a definitive procedure, such as lateral internal sphincterotomy, is considered.

  15. Internal Anal Sphincter Function Following Lateral Internal Sphincterotomy for Anal Fissure

    PubMed Central

    Ram, Edward; Alper, Dan; Stein, Gideon Y.; Bramnik, Zachar; Dreznik, Zeev

    2005-01-01

    Background: Anal fissure is a common and painful disorder. Its relation to hypertonic anal sphincter is controversial. The most common surgical treatment of chronic anal fissure is lateral internal sphincterotomy. Objective: The aim of this study was to evaluate long-term manometric results of sphincter healing following lateral internal sphincterotomy. Patients and Methods: Between 2000 and 2003, 50 patients with anal fissure were included in this study and underwent sphincterotomy; 12 healthy patients served as controls. All patients with anal fissure underwent manometric evaluation using a 6-channel perfusion catheter. All patients were examined 1 month before surgery and 1, 3, 6, and 12 months following surgery. The control group had 3 manometric evaluations 6 months apart. Results: The mean basal resting pressure before surgery was 138 ± 28 mm Hg. One month after surgery, the pressure dropped to 86 ± 15 mm Hg (P < 0.0001) and gradually rose to a plateau at 12 months (110 ± 18 mm Hg, P < 0.0001). At 12 months, the manometric pressure was significantly lower than the baseline (P < 0.0001). However, manometric measurements in the fissure group were still significantly higher than in the control group (110 ± 18 versus 73 ± 4.8 mm Hg, P < 0.0001). All patients were free of symptoms at the 12-month follow-up. Conclusion: Lateral internal sphincterotomy caused a significant decline in the resting anal pressure. During the first year following surgery, the tone of the internal anal sphincter gradually increased, indicating recovery, but still remained significantly lower than before surgery. However, postoperative resting pressures were higher than those in the control, and no patient suffered any permanent problems with incontinence, so this decrease may not be clinically significant. PMID:16041211

  16. Anal fissures associated with targeted therapies in ovarian cancer.

    PubMed

    Squires, Jennifer

    2009-12-01

    Although ovarian cancer remains a leading cause of gynecologic cancer death, targeted therapies are improving patient outcomes. Anal fissures are a side effect of targeted therapies that can disrupt or stop treatment regimens. Diagnosis and management of anal fissures by advanced practice nurses are crucial for maintaining the quality of life of patients with ovarian cancer.

  17. Anal fissures and anal scars in anal abuse--are they significant?

    PubMed

    Pierce, Agnes M

    2004-05-01

    The notes of 214 children who, over a period of 7 years, had been referred after an allegation or a suspicion of any form of child abuse, were examined retrospectively to establish the pattern of injury found, especially with regard to anal fissures or scars. These were all children who had had their genitalia examined at the time of their referral. In 81 children (Group A) who had no history or evidence of sexual abuse, two fissures were found, both with medical explanations for their presence. In 83 (Group B) who alleged sexual abuse but denied anal abuse, nine (11%) had fissures or scars, and in four of the nine there was a history of significant constipation at some time. In 50 children (Group C) who had a strong history of anal abuse, 41 (84%) had fissures or scars. The diagnosis in 13 of these cases was considered definite because there was a confession or guilty plea from the abuser; in the remainder, the diagnosis was "not proven" despite a strong history or gross anal signs and regardless of the verdict in court proceedings. The significance of the findings was discussed with a view to clarifying the relative importance of anal fissures in children with a strong history of anal abuse.

  18. [Evaluation of the efficacy of a new graduated anal dilator in the treatment of acute anal fissures].

    PubMed

    Gaja, Fabio; Trecca, Antonello

    2007-01-01

    Dilatation of the anal sphincter with anal dilators for the treatment of acute anal fissure is efficacious, economic and safe but not always correctly executed with a negative repercussions on the technical results. Our study was aimed at comparing the efficacy of new graduated dilator with a progressively graduated diameter, using a standard treatment schedule, or a free schedule in comparison with the use of multiple classic dilators currently available for the resolution of anal fissures. A series of 60 patients, 35 female and 25 male, with a clinical diagnosis of acute anal fissure in the absence of a hypotonic anal sphincter, abscess or perianal fistula, hemorrhoidal thrombosis, chronic inflammatory bowel diseases or lower gastrointestinal neoplasms were preliminarily evaluated with the solid sphere test and randomly divided into three groups: the first was treated with the new graduated dilator with a standard treatment schedule (20 patients); the second was treated with multiple anal dilators (20, 23, 27 mm) (20 patients) using a standard treatment schedule, and the third group (20 patients) was treated with the new graduated dilator according to a free treatment schedule. After four weeks of treatment, 91% of all patients showed resolution of the anal fissure. Patients treated with new graduated dilator and those treated with multiple dilators according to the standard schedule showed similar 90% rates of fissure healing in comparison to the 92% treated with the graduated dilator according to the free schedule. The tolerability and manageability of the new single graduated dilator was judged positively by all patients in the treated groups. The use of the graduated anal dilator according to a free treatment schedule seems to induce lasting resolution of acute anal fissures with similar results to those achieved using traditional multiple dilators, while proving better tolerated by the patients.

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

    PubMed

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

    2000-06-01

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

  20. Cost considerations in the treatment of anal fissures.

    PubMed

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

    2014-08-01

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

  1. Nonsurgical approaches for the treatment of anal fissures.

    PubMed

    Dhawan, Sanju; Chopra, Sunny

    2007-06-01

    Chronic anal fissure (CAF) is usually associated with internal anal sphincter spasm, the relief of which is central to provide fissure healing. The treatment for CAF has undergone a transformation in recent years from surgical to medical. Both the approaches share the common goal of reducing the spasm. Though surgical treatment has a high success rate, it can permanently impair fecal continence in a large number of patients. Smooth muscle relaxation seems to be a novel way by which more than 60% of the patients can be cured with the topical use of the agents. This treatment is in addition to the normalization of stools mostly. Smooth muscle relaxation is well tolerated, can be administered on an outpatient basis, does not cause any lesion of the continence organ, and subsequently, does not lead to any permanent latent or apparent fecal incontinence. This review encompasses various agents that are used for smooth muscle relaxation. In addition, it describes various clinical studies reported in the literature with their success rates and side effects.

  2. Oral versus topical calcium channel blockers for chronic anal fissure-a systematic review and meta-analysis of randomized controlled trials.

    PubMed

    Sahebally, Shaheel M; Ahmed, Khalid; Cerneveciute, Raminta; Iqbal, Asif; Walsh, Stewart R; Joyce, Myles R

    2017-08-01

    Chemical sphincterotomy with pharmacological agents is recommended as first line therapy for chronic anal fissures (CAF). Calcium channel blockers (CCB) are associated with similar efficacy but fewer side effects compared to nitrates. However, the optimal formulation (oral versus topical) is unknown. We aimed to perform a systematic review and meta-analysis to compare the effectiveness of oral and topical CCB in the treatment of CAF. PubMed and Embase online databases were searched for relevant articles. Two independent reviewers performed methodological assessment and data extraction. Random effects models were used to calculate pooled effect size estimates. A sensitivity analysis was also carried out. Four randomized controlled trials describing 279 patients (138 in oral, 141 in topical group) were examined. There was significant heterogeneity among studies. On random effects analysis, topical CCB were associated with a significantly lower rate of unhealed fissure (21.3% vs. 38.4%; OR = 2.65, 95% CI = 1.50 to 4.69, p = 0.0008) when compared to oral therapy. However, there were no significant differences in fissure recurrence (5.4% vs. 5.5%; OR = 1.01, 95% CI = 0.31 to 3.33, p = 0.98) or side effects (15.6% vs. 39.1%; OR = 4.54, 95% CI = 0.46 to 44.3, p = 0.19) between topical and oral CCB. On sensitivity analysis, having excluded the most heavily biased trial, topical CCB were associated with significantly fewer side effects compared to oral therapy (4.3% vs. 38.0%; OR = 13.16, 95% CI = 5.05 to 34.3, p < 0.00001). Topical CCB are associated with better healing and fewer side effects when compared to oral therapy but there is no difference in recurrence rates. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Nitroglycerin 0.4% ointment vs placebo in the treatment of pain resulting from chronic anal fissure: a randomized, double-blind, placebo-controlled study

    PubMed Central

    2013-01-01

    Background Complications of chronic anal fissure (CAF) treatments are prompting interest in lower-risk therapies. This study was conducted to compare nitroglycerin (NTG) 0.4% ointment with placebo for pain associated with CAF. Methods In this randomized, double-blind, placebo-controlled trial, patients with one CAF and moderate-to-severe pain (≥50 mm on a 100 mm visual analog scale [VAS]) received 375 mg NTG 0.4% (1.5 mg active ingredient) or 375 mg placebo ointment applied anally every 12 hours for 21 days. The primary end point was change from baseline VAS score in 24-hour pain averaged over days 14–18. Review of data from patients who withdrew early was blinded to treatment. To control for the confounding effects of analgesics, all patients received 650 mg acetaminophen for headache prophylaxis before each application. Results A total of 247 patients were enrolled (NTG, n = 123; placebo, n = 124). The prespecified baseline observation carried forward (BOCF) analysis found no significant difference between groups; however, a last observation carried forward (LOCF) analysis showed a significant advantage for NTG. A post hoc analysis (LOCF/BOCF hybrid) demonstrated a significant adjusted mean difference of −7.0 mm in favor of NTG 0.4% (95% CI −13.6, –0.4; P = .038). Headache was the most common adverse event in the NTG (69.9%) and placebo (47.6%) groups. Conclusions This was the first placebo-controlled study that also controlled for the confounding effects of analgesics used to treat NTG-induced headache. In patients with moderate-to-severe CAF pain, NTG 0.4% ointment effectively reduced CAF pain compared with placebo. Trial registration ClinicalTrials.gov, NCT00522041 PMID:23815124

  4. Maintenance Therapy with Partially Hydrolyzed Guar Gum in the Conservative Treatment of Chronic Anal Fissure: Results of a Prospective, Randomized Study

    PubMed Central

    Izzo, Giuseppe; Di Martino, Natale; Renzi, Adolfo

    2014-01-01

    Purpose. This study was designed to evaluate the role of maintenance therapy with partially hydrolyzed guar gum (PHGG) after topical application of glyceryl trinitrate (GTN) in the conservative treatment of chronic anal fissure (CAF). Methods. From all the patients with CAF observed during the study period, 165 subjects with healed CAF after standard therapy with topical GTN 0.4% ointment were randomized to receive (group II) or not (group I) maintenance therapy with PHGG for 10 months. Clinical and manometric followup was carried out 6 and 12 months after treatment. Results. At six-month followup, median visual analogue scale score was significantly higher in group I if compared with group II. The success and recurrence rate at 12-month followup were, respectively, 38.3% (28/73) in group I versus 58.5% (41/70) in group II (P = 0.019; Fisher's exact test) and 30.2% (13/43) in group I versus 14.5% (7/48) in group II (P = 0.0047; Fisher's exact test). Conclusion. The maintenance therapy with PHGG in patients with healed CAF after chemical sphincterotomy by topical application of GTN 0.4% ointment seems associated with a significant reduction of recurrence rate and with a significant increase of success rate at 12-month followup. PMID:25089280

  5. Endoanal ultrasonographic evaluation of an unhealed anal fissure after the lateral internal sphincterotomy.

    PubMed

    Yucel, E; Akin, M L; Sucullu, I; Filiz, A I; Ozdemir, Y; Yildiz, M

    2013-01-01

    The aim of this study was to evaluate the outcomes of the lateral internal sphincterotomy in patients who had unhealed anal fissures using the endoanal ultrasonography. Lateral internal sphincterotomy is an effective method in treatment of chronic anal fissures, but it is associated with 1 to 5 % unhealing and recurrence rates. Endoanal ultrasonography can be used to evaluate the sphincterotomy and the efficiency of the treatment. Totally, 40 patients with unhealed anal fissures after the lateral internal sphincterotomy were enrolled consecutively. The fissures were diagnosed by proctologic examination in every patient. The results of sphincterotomy were evaluated by the endoanal ultrasonography. There were 23 men and 17 women with the median age 29.7 years (range, 20-44 years). Using the endoanal ultrasonography, an incomplete internal sphincterotomy was detected in 26 of patients. In 12 patients, while the internal sphincter was completely intact, a superficial (subcutaneous) external anal sphincterotomy was found. In two patients, although the internal sphincterotomy was observed to be sufficient, a localized abscess formation of less than 1 cm was detected at the anal crypts level. The use of endoanal ultrasonography in patients with unhealed or recurrent anal fissure is a beneficial diagnostic method in assessing the situations of sphincters after the lateral internal sphincterotomy. Although the lateral internal sphincterotomy is a successful surgical treatment and can be performed easily as an outpatient procedure, it should be performed with the correct and rigorously surgical technique (Tab. 2, Fig. 3, Ref. 31).

  6. Comparison of Topical Nifedipine With Oral Nifedipine for Treatment of Anal Fissure: A Randomized Controlled Trial

    PubMed Central

    Golfam, Farzaneh; Golfam, Parisa; Golfam, Babak; Pahlevani, Puyan

    2014-01-01

    Background: Medical sphincterotomy has gained popularity as a treatment for anal fissure. Calcium channel blockers in topical forms could also be appropriate with low adverse effects. Objectives: This was a prospective randomized controlled trial to compare topical and oral nifedipine in the treatment of chronic anal fissure. Patients and Methods: A prospective randomized controlled trial was conducted at two centers of Shahed University. One hundred and thirty patients with chronic anal fissure aged 18 to 60 years managed in our clinics were included in this study. The patients were randomly divided into two groups. Sixty-five patients received topical nifedipine (TN) and the same number received oral nifedipine (ON). Results: Ulcer healing occurred in 43 (73.33%) of topical nifedipine group compared to 29 (49.5%) patients in oral nifedipine, which was significantly different (P < 0.05). Side effects such as headache and flushing in oral nifedipine group were more prevalent than topical nifedipine, which was statistically different. Recurrence rates were the same after six months of follow-up. Conclusions: Although oral nifedipine can reduce symptom and signs of anal fissure, topical nifedipine has a superior role for anal fissure treatment with higher healing rate and lower side effects. PMID:25389477

  7. Comparison of captopril (0.5%) cream with diltiazem (2%) cream for chronic anal fissure: a prospective randomized double-blind two-centre clinical trial.

    PubMed

    Ala, S; Enayatifard, R; Alvandipour, M; Qobadighadikolaei, R

    2016-05-01

    This study compared the efficacy of topical captopril with topical diltiazem in the treatment of chronic anal fissure (CAF). Fifty patients aged between 15 and 75 years with CAF were included in a prospective randomized, double-blind clinical trial. They were randomly allocated to either captopril (0.5%) cream or diltiazem (2%) cream in a dose of 2 cm of cream on the perianal skin every 12 h for 8 weeks. The intensity of pain upon defaecation was evaluated every 10 days using a visual analogue scale. Bleeding on defaecation, pruritus and the presence of perianal irritation were also recorded before and during the trial. The average pain scores were lower in the diltiazem group on the 20th and 30th days. From day 40 to the end of the trial the average pain scores of the two groups did not differ significantly. There were no significant differences in bleeding or perianal irritation between the groups, but the incidence of pruritus was considerably higher in the captopril group, and at the end of the trial 45.8% of the patients in this group still suffered from pruritus. Topical captopril and diltiazem were found to be equally effective in the management of pain, bleeding and perianal irritation due to CAF, but due to the high incidence of pruritus observed with topical captopril this medication is not recommended for the treatment of CAF. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  8. [Sexual dysfunction is frequent in patients with anal fistulas and anal fissures].

    PubMed

    Broholm, Malene; Møller, Henrik; Gögenur, Ismail

    2015-02-23

    Anal fistulas and fissures are frequent disorders. Affected patients may have significant psychosocial and sexual dysfunction. A few studies have investigated patients with anal fissures and fistulas with regard to sexual dysfunction. These studies showed a significant degree of sexual dysfunction among the affected patients. Data are surprisingly limited in this field. More studies are needed to describe this issue and to define a successful treatment for these patients.

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

    PubMed

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

    2017-01-01

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

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

    PubMed Central

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

    2017-01-01

    Background An anal fissure (AF) is a tear in the epithelial lining of the anal canal. This is a very common condition, but the choice of treatment is unclear. The use of anal dilators is effective, economic, and safe. The aim of the study was to compare the efficacy of two conservative treatments, the use of anal dilators or a finger for anal dilatation, in reducing anal pressure and resolving anal fissures. Methods Fifty patients with a clinical diagnosis of AF were randomly assigned to one of the treatments, self-massage of the anal sphincter (group A, 25 patients) or passive dilatation using dilators (group B, 25 patients). All patients were evaluated at baseline, at the end of treatment, and after 12 weeks and 6 months. Pain was measured using a visual analog scale. Results After the treatment, 60% of patients treated with dilators and 80% of patients treated with anal self-massage using a finger showed disappearance of their anal fissures. A comparison between signs and symptoms reported by the patients in the two groups showed a statistically significant reduction in anal pain (group A, P=0.0001; group B, P=0.0001) and bleeding after defecation (group A, P=0.001, group B, P=0.001). At 6 months after treatment, a significantly greater reduction in anal pain was observed in Group A compared to Group B (P=0.02). Conclusion The use of anal self-massage with a finger appears to induce a better resolution of acute anal fissure than do anal dilators, and in a shorter time. PMID:28655981

  11. Fissurectomy as a treatment for anal fissures in children.

    PubMed Central

    Lambe, G. F.; Driver, C. P.; Morton, S.; Turnock, R. R.

    2000-01-01

    INTRODUCTION: Anal fissures, characterised by painful defecation and rectal bleeding, are common in both children and infants. A significant proportion are resistant to simple laxative therapy, and no simple surgical treatment has been described which does not risk compromising sphincteric function. This study reports the initial experience of fissurectomy as a treatment of this condition. PATIENTS AND METHODS: Over a 36 month period, 37 children with an anal fissure were treated by fissurectomy. There were 14 boys and 23 girls, with an age range of 17 weeks to 12 years. Fissurectomy was performed under general anaesthetic, with additional caudal anaesthesia. Stay sutures were used to avoid the need for an anal retractor, thereby preventing stretching of the internal anal sphincter. Of the 37 operations, 36 (97%) were performed as day cases and all children were discharged on laxative therapy. RESULTS: At review, 6 weeks postoperatively, 30 (81%) were asymptomatic. Six (16%) patients were symptomatic; however, 4 of these had failed to comply with the postoperative laxative regimen. One patient failed follow-up. CONCLUSIONS: Fissurectomy is a successful treatment for anal fissures, when combined with postoperative laxative therapy. As dilatation of the internal anal sphincter is not involved, the risk of iatrogenic faecal incontinence is obviated. Images Figure 1 Figure 2 Figure 3 PMID:10932659

  12. Perianal versus endoanal application of glyceryl trinitrate 0.4% ointment in the treatment of chronic anal fissure: results of a randomized controlled trial. Is this the solution to the headaches?

    PubMed

    Pérez-Legaz, Juan; Arroyo, Antonio; Moya, Pedro; Ruiz-Tovar, Jaime; Frangi, Andres; Candela, Fernando; Oliver, Miguel I; Calpena, Rafael

    2012-08-01

    Application of nitroglycerin (glyceryl trinitrate) ointment with perianal administration is a widely used treatment for chronic anal fissure. However, headache occurs after application in 20% to 70% patients and leads to withdrawal in 10% of patients. The aim of the study was to investigate whether endoanal application of the ointment may lower the frequency of headaches without sacrificing effectiveness. compare the effects of perianal versus endoanal administration of nitroglycerin ointment on frequency of headache and rate of healing in the treatment of chronic anal fissure. This was a prospective randomized clinical trial (ClinicalTrial.gov, NCT01132391). Study participants were consecutive patients with a diagnosis of chronic anal fissure treated at a university teaching hospital in Elche, Alicante, Spain. Patients were randomly assigned to receive perianal (n = 26) or endoanal (n = 26) administration of 0.4% nitroglycerin ointment (375 mg of ointment containing 1.5 mg of glyceryl trinitrate), applied every 12 hours over an 8-week period. The primary endpoint of the study was the number of patients with headache within 3 hours after application of the ointment, analyzed with the intention-to-treat principle. Intensity of headache pain was rated on a 10-point visual analog scale. Secondary endpoints included frequencies of fissure healing, anorectal pain, rectal bleeding, pruritus, and incontinence. Headaches were reported in 14 (54%) patients with perianal treatment and in 6 patients (23%) with anorectal treatment (p = 0.003). The median headache pain score was 6 (range, 0-10) in the perianal group and 4.5 (range, 0-10) in the endoanal group (p = 0.03). Disabling headaches led to crossover from perianal to endoanal treatment in 4 patients (15%), and from endoanal to perianal treatment in 1 patient (4%) (p = 0.004). Of the 4 patients who switched from perianal to endoanal treatment, 2 reported improvement in headaches and 2 stopped treatment. The patient who

  13. The use of 0.2% glyceryl trinirate oinment for anal fissures.

    PubMed

    El Tinay, Omer El Farouq; Guraya, Salman Yousuf

    2005-01-01

    To assess the clinical efficacy of 0.2% glyceryl trinitrate ointment in the management of acute and chronic anal fissures. A prospective clinical study conducted on consecutive patients presented to the surgical clinic of King Khalid University Hospital, Riyadh with acute and chronic anal fissures, from January to December 2003. These patients were treated with topical 0.2% glyceryl trinitrate paste in soft white paraffin three times a day. Patients were examined at regular intervals to evaluate the fissure status, adverse reactions, symptomatic control and recurrence. This study comprised 121 patients, six of them were lost to follow-up and 109 (94.7%) of the remaining 115 patients were cured. Of those cured, 13 patients (11.3%) presented with acute and 102 (88.7%) with chronic fissures. There were 98 male and 17 female patients with median age of 41 years (range, 14-70 years). Complete symptomatic relief was achieved in all patients within one month of therapy. Two patients, with chronic anal fissures presented with recurrent symptoms within one month of the completion of therapy both of them were successfully treated with repeat glyceryl trinitrate course. Treatment had to be terminated in six (5.2%) patients: five (4.3%) experienced intolerable adverse effects and one (0.8%) patient failed to respond. All these patients were successfully treated with lateral internal sphincterotomy. No patient complained of change in continence. Glyceryl trinitrate ointment produces adequate symptomatic control and healing of the anal fissures and can be considered as one of the recommended treatment options.

  14. 0.4% glyceryl trinitrate ointment: new drug. Not useful for anal fissures.

    PubMed

    2008-04-01

    (1) Anal fissures are very painful but often heal spontaneously. After eliminating other diagnoses, various treatments can be tried while waiting for fissures to heal: warm seat baths, local anaesthetics, and adequate fibre and fluid intake. (2) Clinical evaluation of glyceryl trinitrate 0.4% ointment, a nitrate derivative, is mainly based on a double-blind trial versus excipient in 193 adults with "chronic" fissures. This trial failed to show a clinically relevant analgesic effect of glyceryl trinitrate 0.4%, with only a 3-mm difference versus the excipient on a 100-mm pain rating scale. In another trial including 229 patients, neither 0.2% nor 0.4% glyceryl trinitrate was more effective on pain than placebo. (3) Another placebo-controlled trial including 304 adults treated for 8 weeks showed no efficacy of various doses of glyceryl trinitrate, versus the excipient, on the healing of anal fissures. (4) The most frequent adverse effect, as expected with a nitrate derivative, is headache, which affects about two-thirds of patients and is severe in 20% of cases. Abrupt-onset hypotension is a risk during concomitant use of other vasodilatory drugs. (5) There are no data on pregnant women exposed to glyceryl trinitrate. (6) In summary, glyceryl trinitrate 0.4% ointment does not reduce the pain linked to chronic anal fissures, but it does carry a risk of sometimes severe headache. It is best to continue using simple, non-aggressive treatments.

  15. 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.

  16. Anal fissures in infants may be a pathognomonic sign of infants with cow's milk allergy.

    PubMed

    Jirapinyo, Pipop; Densupsoontorn, Narumon; Kangwanpornsiri, Channagarn

    2013-07-01

    To study the association between analfissures and cow's milk allergy (CMA) in infants. METHODS AND METHOD: In a prospective study, 72 confirmed cases of CMA in infants were examined for anal fissure by pediatricians with five years' experience. A positive finding was defined as when an anal fissure was detected by at least two out of three examiners. Of infants with CMA with and without gastrointestinal GI symptoms, 79% and 83% had anal fissures, respectively The prevalence of anal fissure in these infants is significantly higher than in normal infants. Anal fissure may be a pathognomonic sign of cow's milk allergy in infants.

  17. 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

  18. Injections of botulinum A toxin for the treatment of anal fissures.

    PubMed

    Trzciński, Radzisław; Dziki, Adam; Tchórzewski, Marcin

    2002-01-01

    To find out how injections of botulinum A toxin influence the healing of anal fissures. Retrospective study. Medical University of Lodz, Poland. 13 patients (6 women, 7 men), mean age 49 (range 31-78), treated with injections of botulinum A toxin 50 units on either side of the anal fissure into the internal anal sphincter from May to December 1999. Complications and relapse. Seven fissures had healed by one month and four by two months. Two remained unhealed but asymptomatic. There was no incontinence of flatus or faeces after three months of treatment. Resting anal pressure was significantly lower in 10 of 13 patients compared with before treatment (p < 0.05). One fissure relapsed after 4 months and this patient had a successful anal stretch. Injection of botulinum A toxin gives good results in the treatment of anal fissures.

  19. Risk factors special to eastern culture for the development of anal fissure.

    PubMed

    Erel, Serap; Adahan, Didem; Kismet, Kemal; Caylan, Ayse; Tanrikulu, Yusuf; Akkus, Mehmet Ali

    2009-01-01

    To reveal the effect of diet, bowel functions and toilet habits on the development of anal fissure. One hundred patients complaining of anal fissure were included to the case group; and one hundred age- and gender-matched patients referred for other reasons except for anorectal complaints were included to the control group. The information was obtained by face to face interviews using questionnaires. Statistically significant differences were found in coffee, fruit, and meat consumption between the groups. The patients suffering from anal fissure avoided paprika consumption. The rate of anal fissure incidence was higher in squat toilet users. This study is the first study which evaluates the risk factors such as paprika consumption and squat toilet usage that are specific to Eastern culture. Further studies including large numbers of population are needed to evaluate different risk factors for anal fissure development (Tab. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.

  20. Novel delivery of botulinum toxin for the treatment of anal fissures.

    PubMed

    Bhardwaj, R; Drye, E; Vaizey, C

    2006-05-01

    Botulinum toxin A (Botox) has been used as a local treatment for anal fissure since 1994. It effects a reversible chemical sphincterotomy without the need for patient compliance. This study examines the feasibility of injecting the treatment using a needle-less system. The optimal angle for injection was determined in a preclinical study using fresh porcine specimens. Ten patients with chronic anal fissures were then injected with 20 units Botox at the site of the fissure. They underwent assessment with a visual analogue pain scale, incontinence score and anal manometry pre-injection, at 48 h postinjection and at six and 12 weeks postinjection. They were also examined at the initial and final visits. The optimal angle for injection was 60 degrees . All 10 patients (5 male; median age 40.5 years (range 26-68 years)) attended the 48 h follow up visit but only seven attended the six and 12 week visits. Six of seven patients healed their fissures. The remaining three were contacted by telephone at six months post injection and two of three remained asymptomatic without further treatment. In seven patients who underwent full follow up the median pain score pre-injection was 5.5 out of 10 (range 1-10) and this dropped to a median of 1 (range 0-6) at 12 weeks. The median drop in resting pressure was 47 cm H2O or 37% at six weeks. No needle injection of Botox is feasible with similar healing rates and reduction of resting pressure to conventional injection techniques.

  1. Randomised controlled trial shows that glyceryl trinitrate heals anal fissures, higher doses are not more effective, and there is a high recurrence rate

    PubMed Central

    Carapeti, E; Kamm, M; McDonald, P; Chadwick, S; Melville, D; Phillips, R

    1999-01-01

    BACKGROUND—Topical application of glyceryl trinitrate (GTN) ointment heals chronic anal fissures, providing an alternative to the traditional first line treatment of surgical sphincterotomy. 
AIMS—To determine the most effective dose of topical GTN for treatment of chronic anal fissures and to assess long term results. 
METHODS—Seventy consecutive patients with chronic anal fissure, were randomly allocated to eight weeks treatment with placebo, 0.2% GTN three times daily, or GTN starting at 0.2% with weekly 0.1% increments to a maximum of 0.6%, in a double blind study. 
RESULTS—After eight weeks fissure had healed in 67% of patients treated with GTN compared with 32% with placebo (p=0.008). No significant difference was seen between the two active treatments. Headaches were reported by 72% of patients on GTN compared with 27% on placebo (p<0.001). Maximum anal sphincter pressure reduced significantly from baseline by GTN treatment (p=0.02), but not placebo (p=0.8). Mean pain scores were lower after treatment with GTN compared with placebo (NS). Of fissures healed with placebo 43% recurred, compared with 33% of those healed with 0.2% GTN and 25% healed with escalating dose GTN (p=0.7). 
CONCLUSIONS—GTN is a good first line treatment for two thirds of patients with anal fissure. An escalating dose of GTN does not result in earlier healing. Significant recurrence of symptomatic fissures and a high incidence of headaches are limitations of the treatment. 

 Keywords: glyceryl trinitrate; anal fissures PMID:10205213

  2. A systematic review and meta-analysis of the treatment of anal fissure.

    PubMed

    Nelson, R L; Manuel, D; Gumienny, C; Spencer, B; Patel, K; Schmitt, K; Castillo, D; Bravo, A; Yeboah-Sampong, A

    2017-08-09

    .07-0.21). Most of the other studies were downgraded in GRADE due to imprecision. LIS is superior to non-surgical therapies in achieving sustained cure of fissure. Calcium channel blockers were more effective than GTN and with less risk of headache, but with only a low quality of evidence. Anal incontinence, once thought to be a frequent risk with LIS, was found in various subgroups in this review to have a risk between 3.4 and 4.4%. Among the surgical studies, manual anal stretch performed worse than LIS in the treatment of chronic anal fissure in adults. For those patients requiring surgery for anal fissure, open LIS and closed LIS appear to be equally efficacious, with a moderate GRADE quality of evidence. All other GRADE evaluations of procedures were low to very low due mostly to imprecision.

  3. Health-related quality of life in patients with anal fissure: effect of type D personality

    PubMed Central

    Yilmaz, Edip Erdal; Canan, Fatih; Yildirim, Osman; Cetin, Mehmet Mustafa

    2014-01-01

    Introduction Health-related quality of life (HRQL) is a significant factor in describing the burden of illness and the impact of treatment in patients with gastrointestinal disease. Type D (distressed) personality is defined as the co-occurrence of negative affect and social inhibition. Aim To assess the prevalence of type D personality in patients with anal fissure and to investigate whether the presence of a type D personality would affect HRQL in patients with anal fissure. Material and methods One hundred outpatients with anal fissure with no psychiatric comorbidity were consecutively enrolled, along with 100 healthy controls. Type D Scale (DS14) and General Health Survey Short Form-36 (SF-36) were used in the collection of data. Results Patients with anal fissure scored lower on physical roles and bodily pain dimensions of SF-36 than healthy subjects (p < 0.05). Thirty-three patients with anal fissure (33%) and 16 controls (16%) had scored above the cut-off score of the DS14 (p < 0.05). Patients with a type D personality were found to score lower on bodily pain and social roles domains of HRQL than patients without a type D personality. Conclusions Type D personality was associated with increased perceived bodily pain and social roles in patients with anal fissure. Type D personality construct may be an important consideration when assessing HRQL outcomes. A multidimensional approach may be valuable in the assessment of patients presenting with anal fissure, because a subgroup with type-D personality might benefit from psychological therapies. PMID:25061489

  4. Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study.

    PubMed

    Poskus, T; Buzinskienė, D; Drasutiene, G; Samalavicius, N E; Barkus, A; Barisauskiene, A; Tutkuviene, J; Sakalauskaite, I; Drasutis, J; Jasulaitis, A; Jakaitiene, A

    2014-12-01

    To identify the incidence and risk factors of haemorrhoids and fissures during pregnancy and after childbirth. Prospective observational cohort study. University hospital and outpatient clinics in Lithuania. A total of 280 pregnant women followed up until 1 month after delivery. Women were examined four times through pregnancy and after delivery; those that developed peri-anal diseases were compared with those that did not. Incidence, time and risk factors of haemorrhoids and fissures. In all, 123 (43.9%) women developed peri-anal disease: 1.6% in the first trimester, 61% during the third trimester, 34.1% after delivery and 3.3% 1 month after delivery; 114 (40.7%) women were diagnosed with haemorrhoids, seven (2.5%) with haemorrhoids and anal fissure and two (0.71%) with anal fissure. Ninety-nine (80.5%) women had vaginal delivery and 24 (19.5%) women had undergone caesarean section. Multivariate analysis identified personal history of peri-anal diseases (odds ratio [OR] 11.93; 95% confidence interval [95% CI] 2.18-65.30), constipation (OR 18.98; 95% CI 7.13-50.54), straining during delivery for more than 20 minutes (OR 29.75; 95% CI 4.00-221.23) and birthweight of newborn>3800 g (OR 17.99; 95% CI 3.29-98.49) as significant predictors of haemorrhoids and anal fissures during pregnancy and perinatal period. Haemorrhoids and fissures are common during the last trimester of pregnancy and 1 month after delivery, with constipation, personal history of haemorrhoids or fissures, birthweight of newborn>3800 g, straining during delivery for more than 20 minutes being independently associated risk factors. © 2014 Royal College of Obstetricians and Gynaecologists.

  5. Efficacy of nitroglycerine ointment in the treatment of pediatric anal fissure.

    PubMed

    Joda, Ali E; Al-Mayoof, Ali F

    2017-04-08

    Anal fissure is the most common anal disease in children. In the past few decades, the understanding of its pathophysiology has led to a progressive reduction in invasive procedures in favor of conservative treatment based on stool softeners and the relaxation of the anal sphincter. This randomized controlled study assessed the safety and efficacy of nitroglycerine (NTG) ointment in the treatment of pediatric anal fissure, which had not yet been proved. An unequal randomized controlled study included 105 pediatric patients with anal fissure who had presented to the private and outpatient clinics of the Central Teaching Hospital of Pediatrics during the period from February 2015 to May 2016. The control group consisted of 70 patients. Both groups were treated with classical conservative therapy of sitz bath, stool softener, and local anesthetic. In the second group, chemical sphincterotomy with 0.2% NTG ointment was used in 35 patients, and was applied at the anal canal twice daily for 8weeks. The primary outcomes of symptomatic improvement and healed fissure, as well as side effects, were analyzed. The average age of patients was 2years (range, 4months to 5years). Patients in the NTG group had 77% symptomatic relief and 60% healed fissure compared to the control group, which had 54% and 32.8% respectively. All were statistically significant. No serious adverse effects were noticed during the treatment period. The use of 0.2% NTG ointment is an effective therapy for anal fissure in children in terms of good healing rate and rapid symptom relief, but it has the drawback of a long treatment period, making patient compliance more difficult, in addition to the problems of tolerance and recurrence. Prospective randomized controlled study (treatment study). Type 2. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Red hot chilli consumption is harmful in patients operated for anal fissure - a randomized, double-blind, controlled study.

    PubMed

    Gupta, Pravin J

    2007-01-01

    This study was aimed to determine whether there was any relationship between consumption of chillies and postoperative symptoms after closed anal sphincterotomy in patients with chronic anal fissure. Patients were randomly assigned to receive analgesics and fiber supplement alone (control patients) or consumption of 1.5 g chilli powder twice daily along with identical fiber and analgesics (chilli group). The evaluation of symptoms (pain, anal burning, and pruritus) during the postoperative period was assessed by means of patients' self-questionnaires. The amount of analgesic tablets consumed and the frequency of stool during the study period were also noted. 28 patients were recruited in each arm. Postoperative symptoms were higher in the group consuming chillies during the first postoperative week. The global scores for postoperative pain (7.60 in chilli group and 2.95 in control group, p < 0.001) and for anal burning (8.85 for the chilli group vs. 4.21 for the control group, p < 0.0001) were significant. This study shows that consumption of red chillies after anal fissure surgery should be forbidden to avoid postoperative symptoms.

  7. Medical and surgical treatment of haemorrhoids and anal fissure in Crohn's disease: a critical appraisal.

    PubMed

    D'Ugo, Stefano; Franceschilli, Luana; Cadeddu, Federica; Leccesi, Laura; Blanco, Giovanna Del Vecchio; Calabrese, Emma; Milito, Giovanni; Di Lorenzo, Nicola; Gaspari, Achille L; Sileri, Pierpaolo

    2013-03-11

    The principle to avoid surgery for haemorrhoids and/or anal fissure in Crohn's disease (CD) patients is still currently valid despite advances in medical and surgical treatments. In this study we report our prospectively recorded data on medical and surgical treatment of haemorrhoids and anal fissures in CD patients over a period of 8 years. Clinical data of patients affected by perianal disease were routinely and prospectively inserted in a database between October 2003 and October 2011 at the Department of Surgery, Tor Vergata University Hospital, Rome. We reviewed and divided in two groups records on CD patients treated either medically or surgically according to the diagnosis of haemorrhoids or anal fissures. Moreover, we compared in each group the outcome in patients with prior diagnosis of CD and in patients diagnosed with CD only after perianal main treatment. Eighty-six CD patients were included in the study; 45 were treated for haemorrhoids and 41 presented with anal fissure. Conservative approach was initially adopted for all patients; in case of medical treatment failure, the presence of stable intestinal disease made them eligible for surgery. Fifteen patients underwent haemorrhoidectomy (open 11; closed 3; stapled 1), and two rubber band ligation. Fourteen patients required surgery for anal fissure (Botox ± fissurectomy 8; LIS 6). In both groups we observed high complication rate, 41.2% for haemorrhoids and 57.1% for anal fissure. Patients who underwent haemorrhoidectomy without certain diagnosis of CD had significantly higher risk of complications. Conservative treatment of proctologic diseases in CD patients has been advocated given the high risk of complications and the evidence that spontaneous healing may also occur. From these preliminary results a role of surgery is conceivable in high selected patients, but definitve conclusions can't be made. Further randomized trials are needed to establish the efficacy of the surgical approach, giving

  8. Anal fissure in children: a 10-year clinical experience with nifedipine gel with lidocaine.

    PubMed

    Klin, Baruch; Efrati, Yigal; Berkovitch, Matitiahu; Abu-Kishk, Ibrahim

    2016-06-01

    We aimed to evaluate efficacy and safety of the use of nifedipine gel with lidocaine in the treatment of acute anal fissures in children by reviewing the cases of 106 children with acute anal fissure treated conservatively by nifedipine gel with lidocaine between the years 2003-2012. The patients included in this study were 48 males and 58 females. Their clinical presentation consisted of constipation, rectal bleeding, anal pain, perianal itching, abdominal pain, irritability and rectal prolapse. Posterior, anterior, both anterior and posterior, multiple, both posterior and lateral locations were the main physical findings in 65, 23, 10, 7, and 1 cases. Ninety-nine patients completed the 4-week treatment course of nifedipine gel with lidocaine successfully (93.40%), with complete healing of the fissure. The recurrence rate observed was very low (6.60%). Topical 0.2% nifedipine with lidocaine appears an efficient mode of treatment for anal fissures in children, with a significant healing rate and no side effects.

  9. Consumption of red-hot chili pepper increases symptoms in patients with acute anal fissures.

    PubMed

    Gupta, P J

    2008-01-01

    Red-hot chili pepper and other spices have been blamed for causing or exacerbating symptoms of anal pathologies like anal fissure and hemorrhoids. This study was aimed to determine if consumption of chilies increases symptoms of acute anal fissures. Individual patients were randomized to receive capsules containing chili or placebo for one week in addition to analgesics and fiber supplement. Patients were asked to note score for symptoms like pain, anal burning, and pruritus during the study period. After one week, cross over treatment was administered to the same group of patients with the same methodology and results were noted at the end of two weeks. Fifty subjects were recruited for this study 43 of them completed the trial (22 in the chili group and 21 in the placebo group). The daily mean pain score was significantly lower in the placebo group in the study period. [Score 2.05 in chili group and 0.97 in placebo group, p<0.001]. There was a significant burning sensation experienced by the patients in the chili group (score 1.85 for the chili group vs. 0.71 for the placebo group, p<0.001). Patient's mean recorded improvement score was significantly higher after taking placebo. 81.3% patients preferred placebo while 13.9% preferred chilies. Two patients had no preference. Consumption of chili does increase the symptoms of acute anal fissure and reduces patient compliance.

  10. Treatment of anal fissures using a combination of minoxidil and lignocaine: a randomized, double-blind trial.

    PubMed

    Muthukumarassamy, Rajakannu; Robinson, Smile S; Sarath, Sistla Chandra; Raveendran, R

    2005-01-01

    Anal fissures are associated with hypertonia of the internal anal sphincter and pain. We evaluated the efficacy of local application of a combination of minoxidil and lignocaine in healing anal fissures. In this prospective, randomized, double-blind study, 90 patients with anal fissure were recruited. Patients received local applications of ointments containing 5% lignocaine (n=28), 0.5% minoxidil (n=36), or both (n=26). Healing of anal fissure at 6 weeks was used as the primary end-point. Rates of complete healing of fissure were similar in the three groups (lignocaine alone 8/27, minoxidil alone 10/34, combination 7/22; p=ns). Mean (SD) time taken for complete healing with combination treatment [1.9 (0.6) weeks] was significantly shorter than that with minoxidil alone (3.1 [1.7] weeks; p=0.001) or with lignocaine alone (3.3 [0.8] weeks; p=0.002). Rates of pain relief were similar in the three groups. Stoppage of bleeding occurred more often with combination treatment than with lignocaine alone. No patient had systemic or local side effects. Combination treatment with minoxidil and lignocaine helps in faster healing of anal fissures and provides better symptomatic relief than either drug alone.

  11. The epidemiology and treatment of anal fissures in a population-based cohort.

    PubMed

    Mapel, Douglas W; Schum, Michael; Von Worley, Ann

    2014-07-16

    Anal fissure (AF) is regarded as a common problem, but there are no published epidemiologic data, nor information on current treatment. The purpose of this study was to examine the incidence, associated comorbidities, and treatment of AF in a population-based cohort. We conducted a retrospective analysis of all persons who were enrolled in one large regional managed care system and treated for AF during calendar years 2005-2011. All persons aged 6 years or older who had a clinic, hospitalization, or surgical procedure associated with AF were identified from utilization data. To identify comorbidities associated with AF, each case was matched by age and gender to 3 controls. There were 1,243 AF cases, including 721 (58%) females and 522 (42%) males; 150 (12%) of the cases occurred in children aged 6-17 years. The overall annual incidence was 0.11% (1.1 cases per 1000 person-years), but ranged widely by age [0.05% in patients 6-17 years to 0.18% in patients 25-34 years]. The incidence also varied by sex, and was significantly higher among females 12-24 years, and among males 55-64 years (P < 0.001). Comorbidities associated with AF included chronic constipation (prevalence 14.2% vs 3.6%), hypothyroidism (14.7% vs 10.4%), obesity (13.0% vs 7.7%), and solid tumors without metastasis (5.2% vs 3.7%) (P < 0.001 for all comparisons). A total of 448 were dispensed a topical prescription medication, 31 had botulinum toxin injection, and only 13 had lateral internal sphincterotomy. AF is a common clinical problem, and the incidence varies substantially by age and sex. Constipation, obesity, and hypothyroidism are associated comorbidities. Most patients are prescribed topical treatments, although it appears that many prescriptions are never filled. Surgical interventions for AF including botulinum toxin and lateral internal sphincterotomy are uncommon.

  12. Anal Fissure

    MedlinePlus

    ... Educational Resources ASCRS Textbook, 3rd Edition CARSEP® CREST® Case Study Listserv International Colon and Rectal Societies and Organizations ... Board of Colon and Rectal Surgery CARSEP® Members Case Study Listserv CREST® Young Surgeons Listserv Quality Assessment and ...

  13. Anal Fissures

    MedlinePlus

    ... the world’s most common cancers. It is the deadliest cancer in the United States.…September 2017September 2017familydoctor.org editorial staff AboutAdvertise with UsCopyright & PermissionsPrivacy PolicyContact FamilyDoctor.org is powered by © 2017 American Academy of Family Physicians

  14. Maintenance therapy with unprocessed bran in the prevention of acute anal fissure recurrence.

    PubMed Central

    Jensen, S L

    1987-01-01

    The effect of unprocessed bran in a dose of 5 g three times daily and a dose of 2.5 g three times daily for one year on the recurrence rate of anal fissures was studied in a double-blind, placebo-controlled trial in 90 patients with recently healed acute posterior anal fissures. Fifteen patients (16.6%) were withdrawn before the code was broken due to failure to follow the trial protocol for various reasons. Significantly fewer recurrences occurred in patients receiving bran 5 g three times daily (recurrence rate 16%, 95% confidence limits, 4.54 to 36.08) when compared with patients receiving bran 2.5 g three times daily (60%; 38.67 to 78.87) (P less than 0.01) and with patients receiving placebo three times daily (68%; 46.50 to 85.05) (P less than 0.01). No significant difference in recurrences was found between patients on bran 2.5 g and those on placebo. PMID:3039130

  15. Medical and surgical treatment of haemorrhoids and anal fissure in Crohn’s disease: a critical appraisal

    PubMed Central

    2013-01-01

    Background The principle to avoid surgery for haemorrhoids and/or anal fissure in Crohn’s disease (CD) patients is still currently valid despite advances in medical and surgical treatments. In this study we report our prospectively recorded data on medical and surgical treatment of haemorrhoids and anal fissures in CD patients over a period of 8 years. Methods Clinical data of patients affected by perianal disease were routinely and prospectively inserted in a database between October 2003 and October 2011 at the Department of Surgery, Tor Vergata University Hospital, Rome. We reviewed and divided in two groups records on CD patients treated either medically or surgically according to the diagnosis of haemorrhoids or anal fissures. Moreover, we compared in each group the outcome in patients with prior diagnosis of CD and in patients diagnosed with CD only after perianal main treatment. Results Eighty-six CD patients were included in the study; 45 were treated for haemorrhoids and 41 presented with anal fissure. Conservative approach was initially adopted for all patients; in case of medical treatment failure, the presence of stable intestinal disease made them eligible for surgery. Fifteen patients underwent haemorrhoidectomy (open 11; closed 3; stapled 1), and two rubber band ligation. Fourteen patients required surgery for anal fissure (Botox ± fissurectomy 8; LIS 6). In both groups we observed high complication rate, 41.2% for haemorrhoids and 57.1% for anal fissure. Patients who underwent haemorrhoidectomy without certain diagnosis of CD had significantly higher risk of complications. Conclusions Conservative treatment of proctologic diseases in CD patients has been advocated given the high risk of complications and the evidence that spontaneous healing may also occur. From these preliminary results a role of surgery is conceivable in high selected patients, but definitve conclusions can’t be made. Further randomized trials are needed to establish the

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

    PubMed

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

    2009-03-01

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

  17. The epidemiology and treatment of anal fissures in a population-based cohort

    PubMed Central

    2014-01-01

    Background Anal fissure (AF) is regarded as a common problem, but there are no published epidemiologic data, nor information on current treatment. The purpose of this study was to examine the incidence, associated comorbidities, and treatment of AF in a population-based cohort. Methods We conducted a retrospective analysis of all persons who were enrolled in one large regional managed care system and treated for AF during calendar years 2005–2011. All persons aged 6 years or older who had a clinic, hospitalization, or surgical procedure associated with AF were identified from utilization data. To identify comorbidities associated with AF, each case was matched by age and gender to 3 controls. Results There were 1,243 AF cases, including 721 (58%) females and 522 (42%) males; 150 (12%) of the cases occurred in children aged 6–17 years. The overall annual incidence was 0.11% (1.1 cases per 1000 person-years), but ranged widely by age [0.05% in patients 6–17 years to 0.18% in patients 25–34 years]. The incidence also varied by sex, and was significantly higher among females 12–24 years, and among males 55–64 years (P < 0.001). Comorbidities associated with AF included chronic constipation (prevalence 14.2% vs 3.6%), hypothyroidism (14.7% vs 10.4%), obesity (13.0% vs 7.7%), and solid tumors without metastasis (5.2% vs 3.7%) (P < 0.001 for all comparisons). A total of 448 were dispensed a topical prescription medication, 31 had botulinum toxin injection, and only 13 had lateral internal sphincterotomy. Conclusions AF is a common clinical problem, and the incidence varies substantially by age and sex. Constipation, obesity, and hypothyroidism are associated comorbidities. Most patients are prescribed topical treatments, although it appears that many prescriptions are never filled. Surgical interventions for AF including botulinum toxin and lateral internal sphincterotomy are uncommon. PMID:25027411

  18. Topical 0.2% glyceryl trinitrate ointment for anal fissures: long-term efficacy in routine clinical practice.

    PubMed

    Jonas, M.; Lund, J. N.; Scholefield, J. H.

    2002-09-01

    OBJECTIVE: Randomized controlled trials have reported fissure healing rates of 60-70% using topical 0.2% GTN ointment, but the effectiveness of this therapy in routine clinical practice, particularly in the long term, is uncertain. This study aimed to evaluate the efficacy of topical GTN for anal fissures in an outpatient setting. PATIENTS AND METHODS: A case note review and postal questionnaire survey were undertaken for patients with a diagnosis of anal fissure dispensed 0.2% GTN ointment from one hospital pharmacy over a two year period (June 1996-May 1998). RESULTS: Ninety-three patients (53 male) applied 0.2% GTN ointment twice daily to the anoderm for anal fissure. They were reviewed on average 8 (2-16), weeks later, by which time 57 (61%) fissures had healed, 33 persisted and 3 patients were lost to follow up. Seventy-two patients (41male), median age 42 (22-83) years, returned completed questionnaires (77% response rate). Forty-nine (68%) had healed with GTN, but 25 had recurrent symptoms after a median of 6 (1-18) months. Sixteen of those patients reporting symptomatic recurrence were prescribed further GTN for a recurrent fissure: 14 (88%) healed, but 2 persisted, and had surgery. In the other nine patients symptoms resolved spontaneously. Thirty-five (49%) experienced headaches, 3 (4%) discontinuing treatment as a result. The median follow up was 25 (13-36) months. CONCLUSION: 0.2% GTN heals 60% of fissures in the outpatient setting but half the patients develop headaches. Up to one third of healed fissures may recur within 18 months but the majority respond to further GTN. Only 4% of patients initially healed with GTN later require sphincterotomy for recurrences.

  19. Prospective clinical trial comparing sphincterotomy, nitroglycerin ointment and xylocaine/lactulose combination for the treatment of anal fissure.

    PubMed

    Karamanlis, E; Michalopoulos, A; Papadopoulos, V; Mekras, A; Panagiotou, D; Ioannidis, A; Basdanis, G; Fahantidis, E

    2010-11-01

    The aim of this study is to compare the ability of three treatments in patients with anal fissure, sphincterotomy, nitroglycerin ointment and combination of gel xylocaine and lactulose. Ninety adults divided in three groups of 30 patients each group, received one of the three treatments in a 3-year interval (2007-2009) and the follow-up was for 2 months. Group A received nitroglycerin ointment, Group B underwent sphincterotomy and Group C received gel xylocaine and lactulose. Concerning pain, after treatment 60% of patients in Group A did not complain of pain, 20% had transient pain, another 10% moderate pain and the remaining 10% had severe pain. In Group B, 95% of the patients had no pain and only 5% had mild, transient pain. In Group C 60% of the patients had moderate pain and the other 40% suffered from severe pain. Concerning fissure healing, in 60% of the patients of Group A, the fissure was healed. In Group B fissure healed in 93.3% and in Group C only in 16.6% of the patients. The "gold standard" for anal fissure treatment is the lateral internal sphincterotomy and that each one of the three methods has its advantages and disadvantages.

  20. [Epidemiology of anal lesions (fissure and thrombosed external hemorroid) during pregnancy and post-partum].

    PubMed

    Abramowitz, L; Batallan, A

    2003-06-01

    Thrombosed external hemorrhoids (TEH) and anal fissure (AF) are 2 frequent sources of anal pains during childbirth. We are going to define their incidences as available in publications and in our experience in Bichat hospital. Then we will define their risk factors. According to Martin's and Corby's studies, AF was observed in 10% of the delivered women. In Bichat hospital we performed a proctological assessment to 165 pregnant women during the last third of pregnancy and within the 2 months following delivery. We observed 2 AF (1,2%) during the first period and 25 (15,2%) during the second. Rouillon et al. reported an incidence of TEH in 12,2% (20/164), while Pradel and al. reported 34% (18/52) of it. In Bichat hospital, 13 women (7,9%) were presenting with TEH during the last third of pregnancy and 33 (20%) in post-partum period. Two studies looked for a statistical correlation between AF and obstetrical, foetal or maternal factors. Corby et al. only pointed the role of constipation. In our study, terminal constipation was the most important risk factor for AF with 5.7 (2.7-12), odds ratio (95% confidence intervals). Rouillon et al. observed more TEH among women with a prolonged first stage labor and a big baby. In our study, a big baby and mother little lips tears were observed more often among women with TEH (P <0,05). Also, we observed only one TEH among the 25 women with caesarean section (4%). Finally, observation that TEH arise immediately after delivery is another argument to support the role of traumatic delivery. We also demonstrated the role of terminal constipation as risk factor for TEH after delivery. To conclude, 1/3 of pregnant women develop AF or TEH after delivery. These 2 pathologies are strongly correlated to terminal constipation. TEH seems equally furthered by traumatic delivery.

  1. Randomized, controlled study comparing sitz-bath and no-sitz-bath treatments in patients with acute anal fissures.

    PubMed

    Gupta, Pravinj

    2006-08-01

    To determine the efficacy and safety of sitz baths in the management of acute anal fissures. Individual patients were randomized to either receive sitz baths or no sitz baths for 4 weeks in addition to oral psyllium husk. Patients were asked to soak their hips and buttocks in a tub containing plain lukewarm water for 10 min, once after defecation in the morning and again at bedtime. Each week, the patients were called to assess pain scores and healing of fissures, whereas the level of satisfaction was recorded at the end of 4 weeks. Main outcome measures were validated pain scores and levels of satisfaction. Fifty-eight subjects were recruited for this study. In all, 52 of them completed the trial (27 in the sitz bath group and 25 in the control group). Although the pain score was lesser in the sitz bath group than in the control group, it failed to reach statistical significance. There were no significant differences in fissure healing between the two groups over the 4-week study period. However, patients in the sitz bath group reported better satisfaction levels than the control group (P < 0.01). Although no serious adverse effects were observed, two patients from sitz bath group developed perianal skin rash. This study suggests that sitz baths improve patient satisfaction in acute anal fissures. However, the healing and overall pain relief was not significant enough to attract attention. It was also found to be associated with adverse effects in few patients.

  2. Hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy.

    PubMed

    Medich, D S; Fazio, V W

    1995-02-01

    The pregnant patient afflicted with a variety of colorectal conditions merits special consideration for reasons related to the safety and timeliness of operation while preserving fetal viability and fertility. The literature is scanty with respect to hemorrhoids, fissures, and colorectal and anal carcinoma. Therefore, the patient has to have a forthright discussion with her physician(s) about the pros and cons of operative and nonoperative approaches, which can result in either therapeutic abortion and timely surgery versus preserving the fetus and taking on the unknown factor of whether delay in treatment will cause an adverse outcome. This underscores the need for a frank discussion with the patient with regard to anticipated outcomes. In benign conditions, there is more latitude to adopt a conservative approach, as the patient's ability to tolerate the symptoms of her condition would dictate the need for definitive operative therapy. In the patient with malignancy, delaying surgical or radiation therapy carries an unknown risk to the patient. Here, the patient's personal views regarding abortion and future fertility dictate the timing of definitive treatment.

  3. Modified-release ointment with nitroglycerin β-cyclodextrin inclusion complex for treatment of anal fissures.

    PubMed

    Centkowska, Katarzyna; Sznitowska, Malgorzata

    2013-10-01

    The aim was to evaluate ointments for local treatment of anal fissures. Nitroglycerin (NTG) was complexed with β-cyclodextrin (β-CD) to provide prolonged NTG release, with the intention of decreasing systemic drug absorption and thus reducing side effects. Gels, creams and anhydrous water-emulsifying (AWE) ointment with NTG-CD were compared with preparations containing uncomplexed NTG (diluted with crospovidone, NTG-cP). The in-vitro NTG release and ex-vivo skin absorption were studied. The prolonged-release ointment with the NTG-CD complex was formulated using AWE base or w/o cream (20% water); release of NTG from a hydrogel was very fast with both the complexed and uncomplexed forms. From the AWE ointment base, 16.4% or 4.5% of the total NTG dose was released after 6 h when NTG-cP or NTG-CD was incorporated, respectively. With the complexed form, NTG absorption to the skin after a 5-h application was 18.1 or 11.1 μg/g from AWE ointment or cream, respectively; absorption of the uncomplexed NTG was higher: 52.3 or 21.9 μg/g from AWE ointment and cream, respectively. Complexation with β-CD results in prolonged release of NTG from AWE ointment and w/o cream, which was confirmed by the ex-vivo skin absorption results. © 2013 Royal Pharmaceutical Society.

  4. Endoscopic lesions in low-to average-risk patients with minimal bright red bleeding from midline anal fissures. How much should we go in?

    PubMed

    Sotoudehmanesh, R; Ainechi, S; Asgari, A A; Kolahdoozan, S

    2007-12-01

    Anal fissure is a common condition in young patients, and the main symptoms include anal pain and bleeding. Our aim was to determine the need to perform lower gastrointestinal endoscopy on patients with midline anal fissure who present with minimal bright red rectal bleeding and who are at low risk for colorectal neoplasia. Patients with midline anal fissure who reported small amounts of red blood on toilet paper, toilet bowl or stool after defecation were evaluated. Patients with alarm signs (recently altered bowel habit, weight loss, anemia and family or personal history of colorectal neoplasms) were excluded. A total of 134 patients (80 female and 54 male, aged 35.8+/-11.4 years) were studied. Patients younger than 40 years underwent flexible sigmoidoscopy and colonoscopy was used for older ones. Fissures were posterior in 106 cases (79.1%) and anterior in 27 cases (20.1%); one patient (0.7%) had both anterior and posterior fissures. The lower gastrointestinal endoscopy was normal in 120 patients (89.6%), and 36 patients (26.9%) had associated internal hemorrhoids. Adenomatous polyps were found in 4 cases (3.0%), ulcerative colitis in 8 (6.0%) and Crohn's disease in one patient (0.7%). There was no case of adenocarcinoma. Clinical evaluation plus rectoscopy might be the appropriate evaluation in this selected group of patients, if our results are confirmed by further studies.

  5. Efficacy of lanolin and bovine type I collagen in the treatment of childhood anal fissures: a prospective, randomized, controlled clinical trial.

    PubMed

    Büyükyavuz, Behçet Ilker; Savaş, Cagri; Duman, Levent

    2010-08-01

    We designed an open-labeled, prospective, randomized, controlled clinical trial to test the efficacy of topical lanolin ointment (PureLan) and bovine type I collagen spray (Gelfix) in the treatment of childhood anal fissures. Seventy-one children with acute anal fissure were divided randomly into three groups: group I (control; n = 25), group II (PureLan; n = 28), and group III (Gelfix; n = 18). All children were assigned to have warm sitz baths, topical analgesic creams, and stool softeners. Patients in groups II and III were also treated with topical lanolin ointment and bovine type I collagen, respectively. All children were re-examined 4 weeks later. Complete healing of the anal fissure was observed in 68% of the group I patients, but in 92.9% and 100% of the group II and III patients, respectively. The difference among groups was significant in terms of complete fissure healing (P = 0.003), but the efficacy of topical lanolin ointment and bovine type I collagen spray did not differ significantly (P = 0.078). Our data suggest that topical lanolin ointment and bovine type I collagen spray are effective in the treatment of acute anal fissure in children.

  6. Efficacy of egg yolk and nitroglycerin ointment as treatments for acute anal fissures: A randomized clinical trial study

    PubMed Central

    Salari, Masoumeh; Salari, Roshanak; Dadgarmoghadam, Maliheh; Khadem-Rezaiyan, Majid; Hosseini, Mousalreza

    2016-01-01

    Background Acute anal fissure as a common disease in society has several etiologies and manifestations such as severe anal pain and bleeding. Nitroglycerin ointment 0.2% is the most common topical treatment used. The most common side effect of nitroglycerin is headache, which is annoying for patients and often leads to discontinuation of the drug. Objective Comparison of egg yolk as a natural substance with analgesic and anti-inflammatory properties and minimal side effects with nitroglycerin ointment in the treatment of acute anal fissure. Methods This randomized clinical trial was carried out during a 10-day period in the Gastroenterology clinic of Ghaem Hospital, Mashhad, Iran (year 2015). 126 patients who filled the inclusion criteria were enrolled. The patients were randomly divided into two groups. Nitroglycerin ointment (0.2%) was applied by patients in the first group, twice daily for 10 days. For the second group, one egg yolk once a day was administered rectally up to 10 days. The pain and bleeding severity were recorded every two days up to 10 days after finishing the treatment course, based on visual scale Results The results showed that egg yolk caused a significant reduction in pain and bleeding compared with nitroglycerin (p<0.05). At the beginning of the study, the difference in pain intensity between the two groups was not statistically significant (p-value = 0.25). However, it became significant in the following days. Changes in the frequency of rectorrhagia were also significant in both groups, showing a major decrease in the number of rectorrhagia cases (p<0.001). Conclusion Egg yolk is more efficient than nitroglycerin in the treatment of acute anal fissure. In addition, lack of any side effects results in the completion of the treatment course by the patients. Trial Registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015050718915N3. Funding This work was supported by a

  7. Efficacy of egg yolk and nitroglycerin ointment as treatments for acute anal fissures: A randomized clinical trial study.

    PubMed

    Salari, Masoumeh; Salari, Roshanak; Dadgarmoghadam, Maliheh; Khadem-Rezaiyan, Majid; Hosseini, Mousalreza

    2016-10-01

    Acute anal fissure as a common disease in society has several etiologies and manifestations such as severe anal pain and bleeding. Nitroglycerin ointment 0.2% is the most common topical treatment used. The most common side effect of nitroglycerin is headache, which is annoying for patients and often leads to discontinuation of the drug. Comparison of egg yolk as a natural substance with analgesic and anti-inflammatory properties and minimal side effects with nitroglycerin ointment in the treatment of acute anal fissure. This randomized clinical trial was carried out during a 10-day period in the Gastroenterology clinic of Ghaem Hospital, Mashhad, Iran (year 2015). 126 patients who filled the inclusion criteria were enrolled. The patients were randomly divided into two groups. Nitroglycerin ointment (0.2%) was applied by patients in the first group, twice daily for 10 days. For the second group, one egg yolk once a day was administered rectally up to 10 days. The pain and bleeding severity were recorded every two days up to 10 days after finishing the treatment course, based on visual scale. The results showed that egg yolk caused a significant reduction in pain and bleeding compared with nitroglycerin (p<0.05). At the beginning of the study, the difference in pain intensity between the two groups was not statistically significant (p-value = 0.25). However, it became significant in the following days. Changes in the frequency of rectorrhagia were also significant in both groups, showing a major decrease in the number of rectorrhagia cases (p<0.001). Egg yolk is more efficient than nitroglycerin in the treatment of acute anal fissure. In addition, lack of any side effects results in the completion of the treatment course by the patients. The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015050718915N3. This work was supported by a grant from the Vice Chancellor of Research of Mashhad University of Medical

  8. Consumption of red-hot chili pepper increases symptoms in patients with acute anal fissures. A prospective, randomized, placebo-controlled, double blind, crossover trial.

    PubMed

    Gupta, Pravin J

    2008-01-01

    Red-hot chili pepper and other spices have been blamed for causing or exacerbating symptoms of anal pathologies like anal fissure and hemorrhoids. To determine if consumption of chilies increases symptoms of acute anal fissures. Individual patients were randomized to receive capsules containing chili or placebo for one week in addition to analgesics and fiber supplement. Patients were asked to note score for symptoms like pain, anal burning, and pruritus during the study period. After 1 week, cross over treatment was administered to the same group of patients with the same methodology and results were noted at the end of 2 weeks. Fifty subjects were recruited for this study. Forty three of them completed the trial (22 in the chili group and 21 in the placebo group). The daily mean pain score was significantly lower in the placebo group in the study period. Score 2.05 in chili group and 0.97 in placebo group. There was a significant burning sensation experienced by the patients in the chili group (score 1.85 for the chili group vs 0.71 for the placebo group). Patients mean recorded improvement score was significantly higher after taking placebo. Eighty one point three percent patients preferred placebo while 13.9% preferred chilies. Two patients had no preference. Consumption of chili does increase the symptoms of acute anal fissure and reduces patient compliance.

  9. A prospective randomized trial betwen subcutaneous lateral internal sphincterotomy with radiofrequency bistoury and conventional parks' operation in the treatment of anal fissures.

    PubMed

    Filingeri, V; Gravante, G

    2005-01-01

    Anal fissure is a frequent proctologic disease. There are many and various treatments adopted to cure this disease. In this study we applied radiofrequencies to the subcutaneous lateral internal sphincterotomy and we compared the techniques in a randomised trial. Patients have been randomized in two groups: in group A 18 patients underwent subcutaneous lateral internal sphincterotomy using radiofrequency bistoury while in group B 17 patients underwent the conventional lateral internal sphincterotomy described by Parks. The mean values for operative time were 6.6 min for group A and 9.1 min for group B. According to pain score, patients' mean values were 1.8 for group A and 1.9 for group B. Healing of the wound was faster in group A than group B, while healing of the anal fissure was approximately the same. Lateral subcutaneous sphincterotomy is the most advantageous operation for the treatment of the idiopathic anal fissure. The radiofrequency bistoury easies the procedure, lessens operating times and healing process of the surgical wounds.

  10. Treatment of first episodes of acute anal fissure: prospective randomised study of lignocaine ointment versus hydrocortisone ointment or warm sitz baths plus bran.

    PubMed Central

    Jensen, S L

    1986-01-01

    One hundred and three patients with an acute first episode of posterior anal fissure were randomised to receive a three week trial of lignocaine ointment (n = 33) versus hydrocortisone ointment (n = 35) or warm sitz baths combined with an intake of unprocessed bran (n =35). Seven patients were withdrawn owing to failure to adhere to the trial protocol. After one and two weeks of treatment symptomatic relief was significantly better among patients treated with sitz baths and bran than among patients treated with lignocaine ointment or hydrocortisone ointment. After three weeks there was no difference in symptomatic relief among the three groups. Patients treated with lignocaine, however, had significantly fewer healed fissures (60%) than patients treated with hydrocortisone (82.4%) or warm sitz baths and bran (87%). In this study warm sitz baths plus an intake of unprocessed bran came out as the treatment of choice for an acute first episode of posterior anal fissure. This treatment is cheap, has no potential serious side effects, and brings the best and quickest relief of symptoms. PMID:3011180

  11. Fibroepithelial polyp in an anal fistulous track: a sign of chronic pathology

    PubMed Central

    Papadopoulos, Iordanis N; Danias, Nikolaos

    2010-01-01

    Hypertrophied anal papillae and fibroepithelial polyps are benign acquired polypoid lesions of the anal canal. The development and protrusion of a fibroepithelial polyp in an anal fistulous track is described. This is a rare physical sign of chronic anal pathology. PMID:22242043

  12. The Clinical Characteristics of Patients with Chronic Idiopathic Anal Pain

    PubMed Central

    Mao, Weiming; Liao, Xiujun; Wu, Wenjing; Yu, Yanyan; Yang, Guangen

    2017-01-01

    Abstract The aim of this study was to investigate the clinical characteristics, treatment outcomes and psychological distress in patients with chronic idiopathic anal pain. The study was conducted on patients referred to Hangzhou Third Hospital for chronic anal pain from January, 2010 to December, 2014. Patient demographics, clinical history, anorectal physiology, and radiological imaging data were recorded for all patients. The treatment outcome was noted for patients treated and followed up for more than 6 month at the present unit. Ninety-six patients with mean age of 45.1 years (range, 17-82) were studied. Seventy-one patients (74.0%) had functional anorectal pain(FARP). The main complaints were dull, sharp, stabbing, or spasm pain. Among all patients, 34.3% reported that their pain radiated into other locations. Fifty-one patients (53.1%) had bowel dysfunction, while 28.1% patients had urinary dysfunction. The common factors associated with pain relief were day time, lying down and warm water baths; the factors that contributed to aggravated pain were night time, defecation or sitting. 92.7% (89/96) of patients reported symptoms of psychological disturbance. FARP patients exhibited increased depression than non-FARP patients(P<0.05). In addition, female patients were more likely to have depression than male patients (P<0.05). The overall pain treatment success rate was 55.2% (53/96). The pain treatment outcome was better in non-FARP patients than in FARP patients(χ2=3.85, P<0.05). Conclusively, chronic idiopathic anal pain is a complex clinical symptom, involving pelvic floor muscles, the nervous system, endocrine system, and the patients’ psychological conditions. Further research is needed to improve diagnosis and treatment for patients with chronic idiopathic anal pain. PMID:28730167

  13. Relationship between anal symptoms and anal findings

    PubMed Central

    Kuehn, Hans Georg; Gebbensleben, Ole; Hilger, York; Rohde, Henning

    2009-01-01

    Background: The frequencies and types of anal symptoms were compared with the frequencies and types of benign anal diseases (BAD). Methods: Patients transferred from GPs, physicians or gynaecologists for anal and/or abdominal complaints/signs were enrolled and asked to complete a questionnaire about their symptoms. Proctologic assessment was performed in the knee-chest position. Definitions of BAD were tested in a two year pilot study. Findings were entered into a PC immediately after the assessment of each individual. Results: Eight hundred seven individuals, 539 (66.8%) with and 268 without BAD were analysed. Almost one third (31.2%) of patients with BAD had more than one BAD. Concomitant anal findings such as skin tags were more frequently seen in patients with than without BAD (<0.01). After haemorrhoids (401 patients), pruritus ani (317 patients) was the second most frequently found BAD. The distribution of stages in 317 pruritus ani patients was: mild (91), moderate (178), severe (29), and chronic (19). Anal symptoms in patients with BAD included: bleeding (58.6%), itch (53.7%), pain (33.7%), burning (32.9%), and soreness (26.6%). Anal lesions could be predicted according to patients' answers in the questionnaire: haemorrhoids by anal bleeding (p=0.032), weeping (p=0.017), and non-existence of anal pain (p=0.005); anal fissures by anal pain (p=0.001) and anal bleeding (p=0.006); pruritus ani by anal pain (p=0.001), itching (p=0.001), and soreness (p=0.006). Conclusions: The knee-chest position may allow for the accumulation of more detailed information about BAD than the left lateral Sims' position, thus enabling physicians to make more reliable anal diagnoses and provide better differentiated therapies. PMID:19277253

  14. Who is at risk for developing chronic anal fistula or recurrent anal sepsis after initial perianal abscess?

    PubMed

    Hamadani, Ali; Haigh, Philip I; Liu, In-Lu A; Abbas, Maher A

    2009-02-01

    This study was designed to determine factors that contribute to chronic anal fistula or recurrent sepsis after initial perianal abscess. A retrospective cohort study was conducted in patients with a first-time perianal abscess who were treated at Kaiser Permanente Los Angeles between 1995 and 2007. Univariate and multivariable analyses were performed with the Cox proportional hazards model to determine predictors of risk for recurrent disease. One hundred and forty-eight patients met inclusion criteria (105 men, 43 women; mean age, 43.6 years). During a mean follow-up of 38 months, the cumulative incidence of chronic anal fistula or recurrent sepsis was 36.5 percent. Univariate and multivariable analyses showed more than two-fold increased risk of recurrence in patients <40 years vs. those >/=40 years (P < 0.01), and univariate analysis showed nondiabetics were 2.69 times as likely to experience recurrence as diabetics (P = 0.04). No significant differences in risk of recurrence were noted for men vs. women (HR = 0.78; P = 0.39), nonsmokers vs. smokers (HR = 1.17; P = 0.58); perioperative antibiotics vs. no antibiotics (HR = 1.51; P = 0.19); or HIV-positive vs. HIV- negative status (HR = 0.72; P = 0.44). Age younger than 40 years significantly increased risk of chronic anal fistula or recurrent anal sepsis after a first-time episode of perianal abscess. Patients with diabetes may have a decreased risk compared with nondiabetic patients. Gender, smoking history, perioperative antibiotic treatment, and HIV status were not risk factors for chronic anal fistula or recurrent anal sepsis.

  15. Sphincterotomy with radio frequency surgery: a new treatment technique of fissure in ano and associated pathologies.

    PubMed

    Gupta, Pravin J

    2003-03-01

    Anal fissures are dealt with using traditional approaches aiming at relieving the anal spasm and minimizing the anal sphincter pressure. Nevertheless, pathologies like sentinel tags, anal papillae, anal polyps, or small hemorrhoids which are often associated with chronic fissures are either considered innocuous, therefore left untreated, or are removed by conventional techniques. In this retrospective, non-randomized study, we performed lateral internal sphincterotomy, which was followed by radio frequency surgical procedures to eliminate the associated pathologies mentioned above. In all, 283 patients were studied. All the patients treated by the method of lateral subcutaneous internal sphincterotomy followed by radio frequency surgical procedure for aforesaid associated pathologies were made comfortable on account of the reduction in pain and irritation during defecation, the pricking or foreign body sensation in the anus and pruritus or wetness around the anal verge. A follow up after 18 months showed that only 7 % of patients had recurrence of symptoms or local signs. This combined approach has been found to be an effective, easy and quick way of treating chronic fissure in ano with associated pathologies

  16. Natural Treatments for Fissure in Ano Used by Traditional Persian Scholars, Razi (Rhazes) and Ibn Sina (Avicenna).

    PubMed

    Derakhshan, Ali Reza

    2016-06-08

    Most cases of chronic fissure do not respond to medical treatment. Razi and Ibn Sina were 2 of the best-known scientists of ancient Persia. The purpose of this study was to find out new scientific evidence in modern medicine about their recommendations, in order to find certain clues to conduct useful researches in the future. First, treatments of anal fissure mentioned by Razi and Ibn Sina were reviewed. Then, literature search was made in electronic databases including PubMed, Scopus, and Google Scholar. Management of anal fissure according to Razi's and Ibn Sina's practices is done based on 3 interventions: lifestyle modifications, drug treatments, and manual procedures. Almost all remedies suggested by Razi and Ibn Sina have shown their effects on fissure in ano via several mechanisms of action in many in vitro and in vivo studies; Still there is lack of human studies on the subject.

  17. [A multicenter randomized controlled clinical trial of Ligation of the Intersphincteric Fistula Tract Plus Bioprosthetic Anal Fistula Plug in the treatment of chronic anal fistula].

    PubMed

    Zheng, Yi; Wang, Zhenjun; Yang, Xinqing; Cui, Jinjie; Chen, Chaowen; Zhang, Xuebin; Wang, Xiaoqiang; Zhang, Xiling; Che, Xiangming; Chen, Jincai; Cui, Feibo; Song, Weiliang; Chen, Yuzhuo

    2015-11-10

    To evaluate the effectiveness and safety of Ligation of the Intersphincteric Fistula Tract Plus Bioprosthetic Anal Fistula Plug (LIFT-plug) in the treatment of chronic anal fistula. A total of 239 patients (199 males, 40 females) with chronic anal fistula were recruited from 5 hospitals between March 2011 and April 2013. These patients were randomly assigned to the experimental group (n=119) treated with LIFT-plug or the control group (n=120) treated with LIFT. The follow-up period was 180 days. The collected data included healing rate, the median healing time, the recurrence rate, the Visual Analogue Scale (VAS), the incontinence rate, and the safety indicators associated with the anal fistula plug. The healing rate of the experimental group was better than the control group (96.5% vs 83.7%, P<0.05). The median healing time of the experimental group was 22 days and the latter was 30 days (P<0.05). By the end of the follow-up period, there was no recurrence found in the two groups. The VAS and the incontinence rate had no statistically significant difference between the two groups. There were no adverse events associated with the anal fistula plug in the experimental group. LIFT-plug is simple, less invasive, and with shorter healing time and more satisfactory healing rate in treating chronic anal fistula compared with LIFT.

  18. [Anal stretching device for patients with chronic prostatitis and chronic pelvic pain syndrome].

    PubMed

    Itza, Fernandok; Zarza, Daniel; Salinas, Jesus; Gómez-Sancha, Fernando; Ximénez, Carmen

    2013-03-01

    Chronic pelvic pain syndrome (CPPS) is a poorly understood and ill-treated condition. It is accompanied by the shortening and increase in tone of the pelvic floor muscles and is closely related to myofascial pain syndrome (MPS). This study aims to evaluate the utility of an anal stretching device (ASD) for improving the pain manifestations of chronic prostatitis (CP) and CPPS. Thirty-one men(38.6 years ± 8.2) were consecutively recruited with an average monitoring period of 14.4 months (± 8.2). The treatment duration was between six months and three years. A clinical history was compiled along with a physical examination and neurophysiological tests. To evaluate pain, the Visual Analogue Scale (VAS) was used before and after treatment; at the final visit, the Clinical Global Impression of Improvement scale (CGI-I) was administered. The ASD is a device that is commercially available in different diameters and lengths. Patients were diagnosed with MPS using neurophysiological tests. Significant differences were found before and after the treatment when evaluating the intensity of the pain using the VAS (6.1±2.1 vs. 1.9±1.3; p < .001). The CGI-I showed a total of 21 patients (70%) whose symptoms were improved or very much improved. Only one patient was worse after the treatment. ASD appears to be a safe and useful tool to treat the pain manifestations of CPPS without notable side effects.

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

    PubMed

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

    2015-01-01

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

  20. 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.

  1. 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

  2. Resting anal pressure, not outlet obstruction or transit, predicts healthcare utilization in chronic constipation: a retrospective cohort analysis

    PubMed Central

    Staller, Kyle; Barshop, Kenneth; Kuo, Braden; Ananthakrishnan, Ashwin N

    2015-01-01

    Background Chronic constipation is common and exerts a considerable burden on health-related quality of life and healthcare resource utilization. Anorectal manometry (ARM) and colonic transit testing have allowed classification of subtypes of constipation, raising promise of targeted treatments. There has been limited study of the correlation between physiological parameters and healthcare utilization. Methods All patients undergoing ARM and colonic transit testing for chronic constipation at two tertiary care centers from 2000 to 2014 were included in this retrospective study. Our primary outcomes included number of constipation-related and gastroenterology visits per year. Multivariate linear regression adjusting for confounders defined independent effect of measures of colonic and anorectal function on healthcare utilization. Key Results Our study included 612 patients with chronic constipation. More than 50% (n=333) of patients had outlet obstruction by means of balloon expulsion testing and 43.5% (n=266) had slow colonic transit. On unadjusted analysis, outlet obstruction (1.98 vs. 1.68), slow transit (2.40 vs 2.07) and high resting anal pressure (2.16 vs. 1.76) were all associated with greater constipation-related visits/year compared to patients without each of those parameters (P<0.05 for all). Outlet obstruction and high resting anal pressure were also associated with greater number of gastroenterology visits/year. After multivariate adjustment, high resting anal pressure was the only independent predictor of increased constipation-related visits/year (P=0.02) and gastroenterology visits/year (P=0.04). Conclusions and Inferences Among patients with chronic constipation, high resting anal pressure, rather than outlet obstruction or slow transit, predicts healthcare resource utilization. PMID:26172284

  3. Anal cancer

    MedlinePlus

    Cancer - anus; Squamous cell carcinoma - anal; HPV - anal cancer ... Anal cancer can start anywhere in the anus. Where it starts determines the kind of cancer it is. Squamous cell carcinoma. This is the most common type of anal cancer. It ...

  4. Anal Cancer

    MedlinePlus

    Anal cancer Overview Anal cancer is an uncommon type of cancer that occurs in the anal canal. The anal canal is a short tube at the end ... your rectum through which stool leaves your body. Anal cancer can cause signs and symptoms such as ...

  5. Anal Cancer

    MedlinePlus

    ... 2345 Phone Search Search Category Cancer A-Z Anal Cancer If you have anal cancer or are close to someone who does, ... cope. Here you can find out all about anal cancer, including risk factors, symptoms, how it is ...

  6. Role of three-dimensional endoanal ultrasound in assessing the anal sphincter morphology of female patients with chronic proctalgia.

    PubMed

    Xue, Ya-Hong; Ding, Shu-Qing; Ding, Yi-Jiang; Pan, Li-Qun

    2017-06-07

    To assess the role of three-dimensional endoanal ultrasound (3D-EAUS) for morphological assessment of the anal sphincter of female patients with chronic proctalgia (CP). In this unmatched case control study, 30 consecutive female patients with CP and 25 normal women (control group) were enrolled. 3D-EAUS was performed in all subjects. Thickness and length of internal anal sphincter (IAS), thickness of puborectalis muscle (PR), length of the external anal sphincter (EAS) plus PR, and puborectalis angle were measured and compared between the two groups. Patients with CP had significantly shorter IAS length and greater PR thickness, as compared to those in normal individuals (26.28 ± 3.59 mm vs 28.87 ± 4.84 mm, P < 0.05 and 9.67 ± 1.57 mm vs 8.85 ± 0.97 mm, P < 0.05, respectively). No significant between-group differences were observed with respect to IAS thickness and the EAS plus PR length (P > 0.05). Puborectalis angle in the CP group was significantly decreased, both in resting (88.23° ± 1.81° vs 89.94° ± 2.07° in control group, P < 0.05) and straining (88.47° ± 3.32° vs 90.72° ± 1.87° in control group, P < 0.05) phases, which suggest the presence of paradoxical contraction of PR in patients with CP. In the CP group, no significant difference in puborectalis angle was observed between the resting and straining phases (88.23° ± 1.81° vs 88.47° ± 3.32° respectively, P > 0.05). The association of greater PR thickness and paradoxical contraction of PR with CP suggest their potential value as markers of CP.

  7. Anal Cancer

    MedlinePlus

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

  8. A randomised trial of simple excision of non-specific hypertrophied anal papillae versus expectant management in patients with chronic pruritus ani.

    PubMed

    Jensen, S L

    1988-11-01

    Forty-one patients with non-specific hypertrophied anal papillae and chronic idiopathic pruritus ani were randomly assigned to simple excision of the anal papillae (n = 21) or expectant management (n = 20). The patients were examined blindly 1 and 4 weeks after treatment and 1 year later. None of the patients were lost to follow-up. Of 21 patients treated with simple excision, 14 (67%) were symptom-free at 1 year after treatment compared to 11 out of 20 patients (55%) maintained on expectant management (P greater than 0.05). It is concluded that simple excision of non-specific hypertrophied anal papillae is without effect on chronic idiopathic pruritus ani.

  9. A randomised trial of simple excision of non-specific hypertrophied anal papillae versus expectant management in patients with chronic pruritus ani.

    PubMed Central

    Jensen, S. L.

    1988-01-01

    Forty-one patients with non-specific hypertrophied anal papillae and chronic idiopathic pruritus ani were randomly assigned to simple excision of the anal papillae (n = 21) or expectant management (n = 20). The patients were examined blindly 1 and 4 weeks after treatment and 1 year later. None of the patients were lost to follow-up. Of 21 patients treated with simple excision, 14 (67%) were symptom-free at 1 year after treatment compared to 11 out of 20 patients (55%) maintained on expectant management (P greater than 0.05). It is concluded that simple excision of non-specific hypertrophied anal papillae is without effect on chronic idiopathic pruritus ani. PMID:3061353

  10. [Anal cytology].

    PubMed

    Tóth, Béla; Sápi, Zoltán; Bánhegyi, Dénes; Marschalkó, Márta; Kárpáti, Sarolta

    2015-01-04

    The incidence of anal cancer has increased in recent decades, particularly among human immunodeficiency virus infected men who have sex with men. Anal intraepithelial neoplasia is a potential precursor lesion of anal cancer. Anal cytology is the primary screening test for anal intraeptithelial neoplasia. The authors aimed to analyze the results of anal cytology of patients with human immunodeficiency virus infection at the National Centre of STD, Department of Dermatology, Dermatooncology and Venereology, Semmelweis University. 155 anal cytological examinations were performed in 140 patients between November 1, 2012 and August 31, 2014. 44% of patients were found to have anal dysplasia, and only 1.6% of patients had high-grade lesions. This rate is lower as compared to published studies including larger number of patients. The study underlines the necessity of screening for anal lesions in the population at-risk.

  11. Anal Warts

    MedlinePlus

    ... Assessment and Safety Committee Initiatives Past Presidents Healthcare Economics Committee Search ... ANAL WARTS Anal warts (condyloma acuminata) are caused by the human papilloma virus (HPV), the most common sexually transmitted ...

  12. Robust pulmonary lobe segmentation against incomplete fissures

    NASA Astrophysics Data System (ADS)

    Gu, Suicheng; Zheng, Qingfeng; Siegfried, Jill; Pu, Jiantao

    2012-03-01

    As important anatomical landmarks of the human lung, accurate lobe segmentation may be useful for characterizing specific lung diseases (e.g., inflammatory, granulomatous, and neoplastic diseases). A number of investigations showed that pulmonary fissures were often incomplete in image depiction, thereby leading to the computerized identification of individual lobes a challenging task. Our purpose is to develop a fully automated algorithm for accurate identification of individual lobes regardless of the integrity of pulmonary fissures. The underlying idea of the developed lobe segmentation scheme is to use piecewise planes to approximate the detected fissures. After a rotation and a global smoothing, a number of small planes were fitted using local fissures points. The local surfaces are finally combined for lobe segmentation using a quadratic B-spline weighting strategy to assure that the segmentation is smooth. The performance of the developed scheme was assessed by comparing with a manually created reference standard on a dataset of 30 lung CT examinations. These examinations covered a number of lung diseases and were selected from a large chronic obstructive pulmonary disease (COPD) dataset. The results indicate that our scheme of lobe segmentation is efficient and accurate against incomplete fissures.

  13. Resolution of constipation, anal stricture, and iron deficiency anemia after iron infusion: an analogy with Plummer Vinson syndrome.

    PubMed

    Arya, Vijaypal; Singh, Shikha; Agarwal, Shashank; Ohri, Arjun

    2016-01-01

    Anal stricture is a disabling condition which is often unresponsive to conservative medical management. The complications of surgical procedures such as dilatations and anoplasty make it a formidable treatment challenge. Through this case, we report and explore a new medical treatment for ano-rectal strictures with an analogy to Plummer Vinson syndrome. A 69-year-old male presented with chronic constipation, rectal pain, and easy fatigability. The physical exam was negative for anal fissure and a digital rectal examination could not be completed because an index finger could not be advanced through the narrowed anus. Laboratory reports revealed microcytic hypochromic anemia with iron deficiency. A colonoscopy performed with a GIF XQ180 OLYMPUS scope, confirmed anal stricture with non-specific colitis. Conservative management with laxatives, high fiber diet, local anesthetics with a trial of mesalamine was initiated but the patient continued to have symptoms. He was referred to a hematologist for an evaluation of anemia and was started on intravenous (IV) iron infusion. The patient's symptoms of constipation, anal stricture and iron deficiency anemia resolved with iron infusion over 3 months. A repeat rectal exam was painless and confirmed resolution of anal stricture. IV iron supplementation combined with conventional anal dilatation presents as a promising approach toward the treatment of anal strictures.

  14. Do hot baths promote anal sphincter relaxation?

    PubMed

    Pinho, M; Correa, J C; Furtado, A; Ramos, J R

    1993-03-01

    Hot perineal baths have been prescribed for the treatment of painful anorectal conditions such as anal fissures and perianal hematomas or for the postoperative care of hemorrhoidectomy. Despite this widely accepted benefit, no studies have been performed to determine whether there is a rational explanation for this procedure. Anorectal manometry was performed in 40 control subjects with no anorectal complaints before and after a hot perineal bath. No significant difference was found between anal pressures at rest or during voluntary contraction before and after the bath. We conclude from this study that no relaxation of anal sphincters can be obtained by hot perineal baths in normal subjects.

  15. Squamous cell carcinoma arising in a chronic osteomyelitic sinus tract in the peri-anal region involving pelvis: a rare occurrence.

    PubMed

    Karumbaiah, K P; Shruthi, M S; Ragavendran, V; Kariappa, T M

    2014-01-01

    Squamous cell carcinoma is a rare, but well documented complication of chronic osteomyelitis. Squamous cell carcinoma arising in a sinus tract following chronic osteomyelitis of the pelvic bone is a very rare occurrence. The patient presented with multiple draining sinuses and an ulcerative growth at the mouth of one of the sinuses in the peri-anal region. X-ray findings and sinogram showed de- struction of part of pubic bone. Biopsy from the growth confirmed a well differentiated squamous cell carcinoma. Therefore it is imperative that these lesions be biopsied for accurate diagnosis, adequate therapy and follow-up.

  16. Defensive anality and anal narcissism.

    PubMed

    Shengold, L

    1985-01-01

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

  17. Anal Itching

    MedlinePlus

    ... irritants. Avoid bubble baths, genital deodorants, perfumed soaps, moist wipes, witch hazel products and other items that might irritate the anal area. Cut back on or avoid coffee, cola, alcohol, citrus fruits, chocolate, spicy foods, tomatoes ...

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

    PubMed

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

    2015-05-01

    The purpose of this study was to describe the anal lesions found in children during a pediatric gastroenterology consultation when the reason for the complaint was related to a digestive disease. This prospective descriptive study included 100 children under 15 years of age over a 13-month period, consulting due to digestive symptoms. The children were under 8 years old (90%) and 25% were under 3.1 years old. Constipation was the most frequent reason for consultation (69%). Fifty-one anal lesions were observed, of which 58.8% were anal fissures, 15.7% were skin tags and 5.8% were venous congestions related to straining. Anal fissures and skin tags were located at the median line, according to the clock-face method in supine position. No child had more than two anal lesions. No anal dilatation, sphincter hypotonia, anal scars, anal lacerations or bruises were found. The two most common anal lesions were anal fissures and skin tags. These anal lesions were mainly observed at the median line and were due to constipation. No cases of multiple anal lesions were found in terms of common digestive diseases. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  19. Intractable colitis associated with chronic granulomatous disease in a young girl.

    PubMed

    Yaman, Aytaç; Kuloğlu, Zarife; Doğu, Figen; İkincioğulları, Aydan; Ensari, Arzu; Çiftçi, Ergin; Kansu, Aydan

    2015-01-01

    Chronic granulomatous disease (CGD) is an autosomal recessive or X-linked disorder caused by NADPH oxidase deficiency leading to an impaired ability of reactive superoxide anion and metabolite formation and recurring severe bacterial and fungal infections, with a high mortality rate. Diarrhea, colitis, ileus, perirectal abscess formation and anal fissures are reported gastrointestinal findings in these patients. We report a case of intractable colitis associated with CGD in a young girl.

  20. [Surgical treatment for cicatrix strictures of anal canal].

    PubMed

    Pomazkin, V I; Mansurov, Iu V

    2011-01-01

    Classification of anal canal strictures with gradation of intensity, extent and localization is proposed. In 12 patients with compensated strictures combination of stenosis and anal fissure served as an indication for operation. These patients underwent fissure excision with dosed sphincterotomy. Anoplasty with displacement of island skin flaps to anal canal defects was carried out to 29 patients with sub-or decompensated strictures after dissection of scarry stricture. Good direct results were achieved in 38 patients. Compensated re-stenosis treated conservatively was observed in 3 patients after anoplasty. It is drawn a conclusion about necessity of differential approach to choice of treatment mode for anal scarry strictures. Anoplasty according to proposed method is considered to be optimal for marked strictures.

  1. Growing Hemorrhagic Choroidal Fissure Cyst

    PubMed Central

    Gelal, Fazıl; Gurkan, Gokhan; Feran, Hamit

    2016-01-01

    Choroidal fissure cysts are often incidentally discovered. They are usually asymptomatic. The authors report a case of growing and hemorrhagic choroidal fissure cyst which was treated surgically. A 22-year-old female presented with headache. Cranial MRI showed a left-sided choroidal fissure cyst. Follow-up MRI showed that the size of the cyst had increased gradually. Twenty months later, the patient was admitted to our emergency department with severe headache. MRI and CT showed an intracystic hematoma. Although such cysts usually have a benign course without symptoms and progression, they may rarely present with intracystic hemorrhage, enlargement of the cyst and increasing symptomatology. PMID:26962426

  2. Pulmonary Fissure Integrity and Collateral Ventilation in COPD Patients

    PubMed Central

    Pu, Jiantao; Wang, Zhimin; Gu, Suicheng; Fuhrman, Carl; Leader, Joseph K.; Meng, Xin; Tedrow, John; Sciurba, Frank C.

    2014-01-01

    Purpose To investigate whether the integrity (completeness) of pulmonary fissures affects pulmonary function in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods A dataset consisting of 573 CT exams acquired on different subjects was collected from a COPD study. According to the global initiative for chronic obstructive lung disease (GOLD) criteria, these subjects (examinations) were classified into five different subgroups, namely non-COPD (222 subjects), GOLD-I (83 subjects), GOLD-II (141 subjects), GOLD-III (63 subjects), and GOLD-IV (64 subjects), in terms of disease severity. An available computer tool was used to aid in an objective and efficient quantification of fissure integrity. The correlations between fissure integrity, and pulmonary functions (e.g., FEV1, and FEV1/FVC) and COPD severity were assessed using Pearson and Spearman's correlation coefficients, respectively. Results For the five sub-groups ranging from non-COPD to GOLD-IV, the average integrities of the right oblique fissure (ROF) were 81.8%, 82.4%, 81.8%, 82.8%, and 80.2%, respectively; the average integrities of the right horizontal fissure (RHF) were 62.6%, 61.8%, 62.1%, 62.2%, and 62.3%, respectively; the average integrities of the left oblique fissure (LOF) were 82.0%, 83.2%, 81.7%, 82.0%, and 78.4%, respectively; and the average integrities of all fissures in the entire lung were 78.0%, 78.6%, 78.1%, 78.5%, and 76.4%, respectively. Their Pearson correlation coefficients with FEV1 and FE1/FVC range from 0.027 to 0.248 with p values larger than 0.05. Their Spearman correlation coefficients with COPD severity except GOLD-IV range from −0.013 to −0.073 with p values larger than 0.08. Conclusion There is no significant difference in fissure integrity for patients with different levels of disease severity, suggesting that the development of COPD does not change the completeness of pulmonary fissures and incomplete fissures alone may not contribute to the

  3. Hyrtl fissure: a historical thriller.

    PubMed

    Mudry, Albert

    2009-06-01

    Hyrtl fissure is an anatomic landmark allowing a transient embryonic communication between the subarachnoid space and the middle ear. It is an eponym characterized by the absence of a known original description. The aim of this study was to try to find and explain the origin of the use of this eponym. Numerous references and original publications were studied to finally demonstrate that Joseph Hyrtl was not able to describe this fissure in the mid-19th century.

  4. Shallow Subsurface Structures of Volcanic Fissures

    NASA Astrophysics Data System (ADS)

    Parcheta, C. E.; Nash, J.; Mitchell, K. L.; Parness, A.

    2015-12-01

    Volcanic fissure vents are a difficult geologic feature to quantify. They are often too thin to document in detail with seismology or remote geophysical methods. Additionally, lava flows, lava drain back, or collapsed rampart blocks typically conceal a fissure's surface expression. For exposed fissures, quantifying the surface (let along sub0surface) geometric expression can become an overwhelming and time-consuming task given the non-uniform distribution of wall irregularities, drain back textures, and the larger scale sinuosity of the whole fissure system. We developed (and previously presented) VolcanoBot to acquire robust characteristic data of fissure geometries by going inside accessible fissures after an eruption ends and the fissure cools off to <50 C. Data from VolcanoBot documents the fissure conduit geometry with a near-IR structured light sensor, and reproduces the 3d structures to cm-scale accuracy. Here we present a comparison of shallow subsurface structures (<30 m depth) within the Mauna Ulu fissure system and their counterpart features at the vent-to-ground-surface interface. While we have not mapped enough length of the fissure to document sinuosity at depth, we see a self-similar pattern of irregularities on the fissure walls throughout the entire shallow subsurface, implying a fracture mechanical origin similar to faults. These irregularities are, on average, 1 m across and protrude 30 cm into the drained fissure. This is significantly larger than the 10% wall roughness addressed in the engineering literature on fluid dynamics, and implies that magma fluid dynamics during fissure eruptions are probably not as passive nor as simple as previously thought. In some locations, it is possible to match piercing points across the fissure walls, where the dike broke the wall rock in order to propagate upwards, yet in other locations there are erosional cavities, again, implying complex fluid dynamics in the shallow sub-surface during fissure eruptions.

  5. Seeded amplification of chronic wasting disease prions in nasal brushings and recto-anal mucosal associated lymphoid tissues from elk by real time quaking-induced conversion

    USGS Publications Warehouse

    Haley, Nicholas J.; Siepker, Chris; Hoon-Hanks , Laura L.; Mitchell, Gordon; Walter, William D.; Manca, Matteo; Monello, Ryan J.; Powers, Jenny G.; Wild, Margaret A.; Hoover, Edward A.; Caughey, Byron; Richt, Jürgen a.; Fenwick, B.W.

    2016-01-01

    Chronic wasting disease (CWD), a transmissible spongiform encephalopathy of cervids, was first documented nearly 50 years ago in Colorado and Wyoming and has since been detected across North America and the Republic of Korea. The expansion of this disease makes the development of sensitive diagnostic assays and antemortem sampling techniques crucial for the mitigation of its spread; this is especially true in cases of relocation/reintroduction or prevalence studies of large or protected herds, where depopulation may be contraindicated. This study evaluated the sensitivity of the real-time quaking-induced conversion (RT-QuIC) assay of recto-anal mucosa-associated lymphoid tissue (RAMALT) biopsy specimens and nasal brushings collected antemortem. These findings were compared to results of immunohistochemistry (IHC) analysis of ante- and postmortem samples. RAMALT samples were collected from populations of farmed and free-ranging Rocky Mountain elk (Cervus elaphus nelsoni; n = 323), and nasal brush samples were collected from a subpopulation of these animals (n = 205). We hypothesized that the sensitivity of RT-QuIC would be comparable to that of IHC analysis of RAMALT and would correspond to that of IHC analysis of postmortem tissues. We found RAMALT sensitivity (77.3%) to be highly correlative between RT-QuIC and IHC analysis. Sensitivity was lower when testing nasal brushings (34%), though both RAMALT and nasal brush test sensitivities were dependent on both the PRNP genotype and disease progression determined by the obex score. These data suggest that RT-QuIC, like IHC analysis, is a relatively sensitive assay for detection of CWD prions in RAMALT biopsy specimens and, with further investigation, has potential for large-scale and rapid automated testing of antemortem samples for CWD.

  6. Thirty-Day Hospital Readmission After Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis for Chronic Ulcerative Colitis at a High-Volume Center.

    PubMed

    McKenna, Nicholas P; Mathis, Kellie L; Khasawneh, Mohammad; Shariq, Omair; Dozois, Eric J; Larson, David W; Lightner, Amy L

    2017-08-24

    Ileal pouch anal anastomosis (IPAA) is associated with a high 30-day hospital readmission rate. Risk factors and etiology of readmission remain poorly defined. We sought to determine the 30-day hospital readmission rate following IPAA at a high-volume center and identify any modifiable perioperative factors. A retrospective review of all patients undergoing two- or three-stage IPAA for chronic ulcerative colitis at our institution between 2002 and 2013 was performed. Analysis was performed on rate of readmission, readmission diagnosis, intervention performed upon readmission, and risk factors for readmission. Thirty-day primary and secondary readmission rates after IPAA were 20.3% (n = 185) and 2.1% (n = 19), respectively. The leading etiologies for readmission included partial small bowel obstruction/ileus (n = 52, 21.9%), pelvic sepsis (n = 43, 18.1%), dehydration (n = 42, 17.7%), and venous thromboembolism (n = 31, 13.1%). While the majority of readmissions were managed medically (n = 119, 65.4%), 19.2% (n = 35) required radiologic intervention and 15.3% (n = 28) required a return to the operating room. On univariate analysis, younger age (p = 0.03) and female sex (p = 0.04) had a significantly increased risk of readmission. On multivariable analysis, BMI ≥ 30 (OR 0.51; 95% CI, 0.25-0.97, p = 0.04) was protective of readmission. Thirty-day hospital readmission following IPAA remains a common problem. Preventable etiologies of readmission include dehydration and venous thromboembolism (VTE). Future quality improvement efforts should focus on education regarding stoma output and extended VTE prophylaxis to decrease hospital readmission rates following IPAA.

  7. Prevalence of and risk factors for anal human papillomavirus infection among young healthy women in Costa Rica.

    PubMed

    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

    2012-10-01

    Anal cancer is caused by human papillomavirus (HPV), yet little is known about anal HPV infection among healthy young women. 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 SPF(10) PCR/DEIA/LiPA(25), version 1. 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. 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. NCT00128661.

  8. Fissure seal or fluoride varnish?

    PubMed

    Deery, Christopher

    2016-09-01

    Data sourcesCochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry PlatformStudy selectionRandomised controlled trials (RCTs) with at least 12 months follow-up, in which fissure sealants, or fissure sealants together with fluoride varnishes, were compared with fluoride varnishes alone for preventing caries in occlusal surfaces of permanent teeth of children and adolescents.Data extraction and synthesisTwo reviewers independently screened search results, extracted data and assessed risk of bias of included studies. Studies were grouped and analysed on the basis of sealant material type (resin-based sealant and glass ionomer-based sealant, glass ionomer and resin-modified glass ionomer) and different follow-up periods. Odds ratio were calculated for caries or no caries on occlusal surfaces of permanent molar teeth. Mean differences were calculated for continuous outcomes and data. Evidence quality was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods.ResultsEight RCTs involving a total of 1747 children aged five to ten years of age were included. Three trials compared resin-based fissure sealant versus fluoride varnish. Results from two studies (358 children) after two years were combined. Sealants prevented more caries, pooled odds ratio (OR) = 0.69 (95%CI; 0.50 to 0.94). One trial with follow-up at four and nine years found that the caries-preventive benefit for sealants was maintained, with 26% of sealed teeth and 55.8% of varnished teeth having developed caries at nine years. Evidence for glass-ionomer sealants was of low quality. One split-mouth trial analysing 92 children at two-year follow-up found a significant difference in favour of resin-based fissure sealant together with fluoride varnish compared with fluoride varnish only (OR

  9. Sylvian Fissure Dermoid Cyst - A Rare case

    PubMed Central

    Anand, Deepak; Soin, Divya; Garg, Ravinder

    2014-01-01

    Intracranial dermoid cysts are rare tumours which usually occur in the midline. Sylvian fissure is a very unusual site for this lesion. This case presents a patient with unruptured dermoid cyst in the left sylvian fissure who was operated successfully without any residual deficit. PMID:25386502

  10. Tooth bleaching and pit and fissure stain.

    PubMed

    Falconer, David Scott; Hamilton, James C; Stoffers, Kenneth W; Gregory, William A

    2008-04-01

    To investigate if tooth whitening had any effect on the shade of occlusal pit and fissure stains and whether reservoirs in bleaching trays affected bleaching of occlusal pit and fissure stains. 96 extracted molars were randomly divided into three paired groups for whitening using a 10% carbamide peroxide solution (Opalescence) or a 22% carbamide peroxide solution (Nite White Excel 3), or tap water for a control. One of each pair utilized reservoirs in their custom bleaching trays. Three dentists evaluated the shade of a specified occlusal area of pit and fissure stain twice before bleaching and twice after bleaching. Pit and fissure stain showed significant lightening of shade for either of the bleaching systems (P < 0.0005) but not the control (P = 0.816). There was no significant difference in pit and fissure stain shade lightening following treatment between those groups utilizing reservoirs in the custom trays and those without reservoirs (P = 0.658).

  11. Modeling plaque fissuring and dissection during balloon angioplasty intervention.

    PubMed

    Gasser, T Christian; Holzapfel, Gerhard A

    2007-05-01

    Balloon angioplasty intervention is traumatic to arterial tissue. Fracture mechanisms such as plaque fissuring and/or dissection occur and constitute major contributions to the lumen enlargement. However, these types of mechanically-based traumatization of arterial tissue are also contributing factors to both acute procedural complications and chronic restenosis of the treatment site. We propose physical and finite element models, which are generally useable to trace fissuring and/or dissection in atherosclerotic plaques during balloon angioplasty interventions. The arterial wall is described as an anisotropic, heterogeneous, highly deformable, nearly incompressible body, whereas tissue failure is captured by a strong discontinuity kinematics and a novel cohesive zone model. The numerical implementation is based on the partition of unity finite element method and the interface element method. The later is used to link together meshes of the different tissue components. The balloon angioplasty-based failure mechanisms are numerically studied in 3D by means of an atherosclerotic-prone human external iliac artery, with a type V lesion. Image-based 3D geometry is generated and tissue-specific material properties are considered. Numerical results show that in a primary phase the plaque fissures at both shoulders of the fibrous cap and stops at the lamina elastica interna. In a secondary phase, local dissections between the intima and the media develop at the fibrous cap location with the smallest thickness. The predicted results indicate that plaque fissuring and dissection cause localized mechanical trauma, but prevent the main portion of the stenosis from high stress, and hence from continuous tissue damage.

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

    PubMed Central

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

    2015-01-01

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

  13. Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles.

    PubMed

    Dodi, G; Bogoni, F; Infantino, A; Pianon, P; Mortellaro, L M; Lise, M

    1986-04-01

    In 26 volunteers without anorectal complaints, and in 31 patients with anorectal problems such as hemorrhoidal disease, anal fissure, and proctalgia fugax, baseline resting anal canal pressures were recorded manometrically for 5 minutes at room temperature (23 degrees C). In 16 volunteers (Group A) and 21 patients (Group B) anorectal manometry was then performed while the anus was immersed in water at varying temperatures (5 degrees C, 23 degrees C, and 40 degrees C). In ten volunteers (Group A') and ten patients (Group B') resting pressures were recorded for an additional 30 minutes following immersion for 5 minutes at 40 degrees C. In all subjects (at least P less than 0.01), resting anal canal pressures diminished significantly from baseline after immersion at 40 degrees C, but remained unchanged in all subjects after immersion at 5 degrees C and 23 degrees C. In Group A', anal canal pressures remained significantly reduced for 15 minutes (P less than 0.02). In Group B', significant reduction in resting pressure lasted 30 minutes (P less than 0.02). Wet heat applied to the anal sphincter apparatus significantly and reproducibly decreased resting anal canal pressures over time, and therefore was likely to benefit patients after anorectal operations and those with anorectal pain.

  14. 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.

  15. Thoracoscopic anterior ‘fissure first’ technique for left lung cancer with an incomplete fissure

    PubMed Central

    Samejima, Joji; Matsuura, Yosuke; Nakao, Masayuki; Uehara, Hirofumi; Nakagawa, Ken; Masuda, Munetaka; Okumura, Sakae

    2016-01-01

    Background Dealing with incomplete lung fissures during thoracoscopic surgery is difficult. Our objective was to evaluate the efficacy and safety of a thoracoscopic anterior ‘fissure first’ technique for dealing with incomplete left lung fissures. Methods One hundred and seventy patients underwent left upper lobectomy or left lower lobectomy between April 2008 and July 2014. Of these, 34 patients underwent surgery using a thoracoscopic anterior ‘fissure first’ technique for incomplete fissures (group A) and 136 underwent surgery using a conventional thoracoscopic method for unfused fissures (group B). A four-port complete thoracoscopic approach was used in all patients. After completion of the fissure, hilar lymphadenectomy was performed in the conventional manner. Results There were no significant differences between the two groups in operating time, blood loss, or duration of chest tube drainage. Patients in group A required more staple cartridges than those in group B (mean number of cartridges, 2.4 vs. 1.1; P<0.01). The two groups did not significantly differ with regard to the prevalence of air leaks (12% vs. 4%; P=0.11), either prolonged or delayed. Conclusions We found that a thoracoscopic anterior ‘fissure first’ technique for left lung cancer with an incomplete fissure enabled hilar lymphadenectomy to be performed in the conventional manner without any increase in the prevalence of air leaks, operating time, or duration of chest tube drainage. This technique should be considered for use in left upper lobectomy or left lower lobectomy in patients with an incomplete fissure. PMID:28066589

  16. Enceladus Near-Fissure Surface Temperatures

    NASA Astrophysics Data System (ADS)

    Howell, Robert R.; Goguen, J. D.; Spencer, J. R.

    2013-10-01

    Recently reported Cassini VIMS observations of thermal emission from the Enceladus south-pole fissures (Goguen et al. 2013) when combined with previous longer wavelength Cassini CIRS observations (Spencer et al. 2006) allow us to better constrain the highest temperatures present, but also require more detailed modeling of the processes which control those highest temperatures. The simplest interpretation of the VIMS observations is that the 3-5 µm thermal radiation comes from the walls within a fissure, rather than the adjacent surface. But as part of investigating that latter alternative it became clear that very high sublimation rates are implied by some predicted surface temperatures. Abramov and Spencer (2009) produced models of the expected surface temperature distribution, assuming conduction of heat through the ice, balanced by thermal radiation at the surface. However as temperature is raised, at 186K sublimation cooling equals radiation, and because it depends exponentially on temperature, it quickly dominates. We have found that including the surface sublimation cooling suppresses the higher temperatures. Regardless of the fissure temperature, surface temperatures above 200K can only be maintained by conduction within a few tens of centimeters of the assumed fissure wall. The high sublimation erosion rates (0.25 m/yr at 180K, rising to over 100 m/yr at 220K) imply that the fixed boundaries we have previously assumed are unrealistic. If these surface temperatures are maintained then either a sublimation lag of non-ice components will accumulate, inhibiting sublimation, or the geometry of the fissure vent will rapidly change. However the rate of change will be limited by the available heat provided by conduction. We are now developing numerical models with moving boundary conditions to explore the time evolution. The simplest result may be that the lip of the fissure erodes back till it no longer remains in thermal contact with the rising vapor which

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

    PubMed

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

    2017-12-01

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

  18. Earth fissures and localized differential subsidence.

    USGS Publications Warehouse

    Holzer, Thomas L.; Pampeyan, Earl H.

    1981-01-01

    Long linear tension cracks associated with declining groundwater levels at four sites in subsiding areas in south-central Arizona, Fremont Valley, California, and Las Vegas Valley, Nevada, occur near points of maximum convex-upward curvature in subsidence profiles oriented perpendicular to the cracks. Profiles are based on repeated precise vertical control surveys of lines of closely spaced bench marks. Association of these fissures with zones of localized differential subsidence indicates that linear earth fissures are caused by horizontal tensile strains probably resulting from localized differential compaction. Horizontal tensile strains across the fissures at the point of maximum convex-upward curvature, ranging from approximately 100 to 700 microstrains (0.01 to 0.07% per year), were indicated based on measurements with a tape or electronic distance meter.

  19. 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.

  20. Anal Disorders - Multiple Languages

    MedlinePlus

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

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

    PubMed Central

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

    2015-01-01

    Background & Aims The anal sphincters and puborectalis are routinely imaged with an endoanal magnetic resonance imaging (MRI) coil, which does not assess co-aptation of the anal canal at rest. Using a MRI torso coil, we identified a patulous anal canal in some patients with anorectal disorders. We aimed to evaluate the relationship between anal sphincter and puborectalis injury, a patulous anal canal, and anal pressures. Methods We performed a retrospective analysis of data from 119 patients who underwent MRI and manometry analysis of anal anatomy and pressures, respectively, from February 2011 through March 2013 at the Mayo Clinic. Anal pressures were determined by high-resolution manometry, anal sphincter and puborectalis injury was determined by endoanal MRI, and anal canal integrity was determined by torso MRI. Associations between manometric and anatomical parameters were evaluated with univariate and multivariate analyses. Results Fecal incontinence (55 patients, 46%) and constipation (36 patients. 30%) were the main indications for testing; 49 patients (41%) had a patulous anal canal, which was associated with injury to more than 1 muscle (all P≤.001) and internal sphincter (P<.01), but not puborectalis (P=.09) or external sphincter (P=.06) injury. Internal (P<.01) and external sphincter injury (P=.02) and a patulous canal (P<.001), but not puborectalis injury, predicted anal resting pressure. A patulous anal canal was the only significant predictor (P<.01) of the anal squeeze pressure increment. Conclusions Patients with anorectal disorders commonly have a patulous anal canal, associated with more severe anal injury, anal resting pressure, and squeeze pressure increment. It is therefore important to identify patulous anal canal because it appears to be a marker of not only anal sphincter injury but disturbances beyond sphincter injury, such as damage to the anal cushions or anal denervation. PMID:25869638

  2. Relationship Among Anal Sphincter Injury, Patulous Anal Canal, and Anal Pressures in Patients With Anorectal Disorders.

    PubMed

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

    2015-10-01

    The anal sphincters and puborectalis are imaged routinely with an endoanal magnetic resonance imaging (MRI) coil, which does not assess co-aptation of the anal canal at rest. By using a MRI torso coil, we identified a patulous anal canal in some patients with anorectal disorders. We aimed to evaluate the relationship between anal sphincter and puborectalis injury, a patulous anal canal, and anal pressures. We performed a retrospective analysis of data from 119 patients who underwent MRI and manometry analysis of anal anatomy and pressures, respectively, from February 2011 through March 2013 at the Mayo Clinic. Anal pressures were determined by high-resolution manometry, anal sphincter and puborectalis injury was determined by endoanal MRI, and anal canal integrity was determined by torso MRI. Associations between manometric and anatomic parameters were evaluated with univariate and multivariate analyses. Fecal incontinence (55 patients; 46%) and constipation (36 patients; 30%) were the main indications for testing; 49 patients (41%) had a patulous anal canal, which was associated with injury to more than 1 muscle (all P ≤ .001), and internal sphincter (P < .01), but not puborectalis (P = .09) or external sphincter (P = .06), injury. Internal (P < .01) and external sphincter injury (P = .02) and a patulous canal (P < .001), but not puborectalis injury, predicted anal resting pressure. A patulous anal canal was the only significant predictor (P < .01) of the anal squeeze pressure increment. Patients with anorectal disorders commonly have a patulous anal canal, which is associated with more severe anal injury and independently predicted anal resting pressure and squeeze pressure increment. It therefore is important to identify a patulous anal canal because it appears to be a marker of not only anal sphincter injury but disturbances beyond sphincter injury, such as damage to the anal cushions or anal denervation. Copyright © 2015 AGA Institute. Published by Elsevier

  3. Identification of the pleural fissures with computed tomography

    SciTech Connect

    Marks, B.W.; Kuhns, L.R.

    1982-04-01

    The pleural fissures can be identified as avascular planes within the pulmonary parenchyma on CT scans. A retrospective analysis of 23 consecutive scans was conducted to consider identification of fissures. On 21% of the axial images, a ''ground glass'' band was identified within the avascular plane, probably due to partial volume averaging of the pleural fissure with the adjacent lung. The pleural fissures could be identified in 84% of cases.

  4. Recent ground fissures in the Hetao basin, Inner Mongolia, China

    NASA Astrophysics Data System (ADS)

    He, Zhongtai; Ma, Baoqi; Long, Jianyu; Zhang, Hao; Liang, Kuan; Jiang, Dawei

    2017-10-01

    Ground fissures are a geological hazard with complex formation mechanisms. Increasing amounts of human activity have created more ground fissures, which can destroy buildings and threaten human security. Some ground fissures indicate potentially devastating earthquakes, so we must pay attention to these hazards. This paper documents recently discovered ground fissures in the Hetao basin. These ground fissures are located along the frontal margins of the terraces of the Sertengshan piedmont fault. These fissures are 600-1600 m long, 5-50 cm wide, and at most 1 m deep. These ground fissures emerged after 2010 and ruptured newly constructed roads and field ridges. The deep geodynamic mechanisms within this extensional environment, which is dominated by NE-SW principal compressive shear, involve N-S tensile stress, which has produced continuous subsidence in the Hetao basin and continuous activity along the Sertengshan piedmont fault since the late Quaternary. Trenches across the ground fissures reveal that the fissures are the latest manifestation of the activity of preexisting faults and are the result of creep-slip movement along the faults. The groundwater level in the Hetao basin has been dropping since the 1960s because of overexploitation, resulting in subsidence. When the tensile stress exceeds the ultimate tensile strength of the strata, the strata rupture along preexisting faults, producing ground fissures. Thus, the Sertengshan piedmont fault planes are the structural foundation of the ground fissures, and groundwater extraction induces the development of ground fissures.

  5. Pharmacotherapy of Anal Cancer.

    PubMed

    Rogers, Jane E; Eng, Cathy

    2017-08-02

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

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

    PubMed

    McBride, Kimberly R; Fortenberry, J Dennis

    2010-03-01

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

  7. 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

  8. Anal itching -- self-care

    MedlinePlus

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

  9. [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.

  10. 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.

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

    PubMed Central

    2014-01-01

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

  12. 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.

  13. Hydraulic fracturing in tight, fissured media

    SciTech Connect

    Warpinski, N.R. )

    1991-02-01

    Large volumes of natural gas are found in tight, fissured reservoirs. Hydraulic fracturing can enhance recovery, but many complications, such as pressure-sensitive or accelerated leakoff, damage, and complex fracturing, arise during treatment of such reservoirs. This paper reports that special procedures generally should be considered during breakdown and fracturing of these reservoirs. In addition, the use of alternative stimulation strategies may be beneficial.

  14. Ultrasound anal sphincter defects and 3D anal pressure defects.

    PubMed

    Mion, F; Garros, A; Damon, H; Roman, S

    2017-04-13

    We read with interest the paper by Rezaie et al. on the use of 3D high definition anorectal manometry (3DARM) to detect anal sphincter defects in patients with faecal incontinence [1]. In their series of 39 patients, they described a new metrics to define anal pressure defect (defect of at least 18° of the 25 mmHg isobaric contour on anal resting pressures), and then compared the results of pressure defects determined by 3DARM and 3D anal ultrasound results. They found a rather good negative predictive value of manometry to eliminate the presence of ultrasound anal sphincter defects (92%), and suggested the possibility to use 3DARM to rule out anal sphincter defects and avoid the need of anal ultrasound in selected patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  15. Anatomy and approaches along the cerebellar-brainstem fissures.

    PubMed

    Matsushima, Ken; Yagmurlu, Kaan; Kohno, Michihiro; Rhoton, Albert L

    2016-01-01

    OBJECT Fissure dissection is routinely used in the supratentorial region to access deeply situated pathology while minimizing division of neural tissue. Use of fissure dissection is also practical in the posterior fossa. In this study, the microsurgical anatomy of the 3 cerebellar-brainstem fissures (cerebellomesencephalic, cerebellopontine, and cerebellomedullary) and the various procedures exposing these fissures in brainstem surgery were examined. METHODS Seven cadaveric heads were examined with a microsurgical technique and 3 with fiber dissection to clarify the anatomy of the cerebellar-brainstem and adjacent cerebellar fissures, in which the major vessels and neural structures are located. Several approaches directed along the cerebellar surfaces and fissures, including the supracerebellar infratentorial, occipital transtentorial, retrosigmoid, and midline suboccipital approaches, were examined. The 3 heads examined using fiber dissection defined the anatomy of the cerebellar peduncles coursing in the depths of these fissures. RESULTS Dissections directed along the cerebellar-brainstem and cerebellar fissures provided access to the posterior and posterolateral midbrain and upper pons, lateral pons, floor and lateral wall of the fourth ventricle, and dorsal and lateral medulla. CONCLUSIONS Opening the cerebellar-brainstem and adjacent cerebellar fissures provided access to the brainstem surface hidden by the cerebellum, while minimizing division of neural tissue. Most of the major cerebellar arteries, veins, and vital neural structures are located in or near these fissures and can be accessed through them.

  16. Earth Fissures in Su-Xi-Chang Region, Jiangsu, China

    NASA Astrophysics Data System (ADS)

    Wang, Guang-ya; You, Greg; Zhu, Jin-qi; Yu, Jun; Li, Wei

    2016-11-01

    The earth fissures in the Su-Xi-Chang area are caused by differential land subsidence due to long-term excessive groundwater withdrawal and controlled by the bedrock ridge or cliff underlying. There have been more than 15 earth fissures in the area since 1989. The field investigations have lasted for more than 20 years. The earth fissures generally have a main fissure and a number of secondary ones parallel to the main one. The main fissure (crack) has a scarp, is steeply dipping, and can be more than 2000 m long. Geophysical surveys (2D or 3D seismic investigation, controlled source audio frequency magnetotelluric sounding, and electric sounding) combined with geological drilling are effective for the investigation of earth fissures. Geodetic leveling is effective to monitor the ground deformation across the earth fissure, so is the extensometer for the opening of the fissure. The activities of earth fissures are directly related to different stages of land subsidence and controlled by geological abnormalities. Most earth fissures in the area are still active.

  17. Lung fissure detection in CT images using global minimal paths

    NASA Astrophysics Data System (ADS)

    Appia, Vikram; Patil, Uday; Das, Bipul

    2010-03-01

    Pulmonary fissures separate human lungs into five distinct regions called lobes. Detection of fissure is essential for localization of the lobar distribution of lung diseases, surgical planning and follow-up. Treatment planning also requires calculation of the lobe volume. This volume estimation mandates accurate segmentation of the fissures. Presence of other structures (like vessels) near the fissure, along with its high variational probability in terms of position, shape etc. makes the lobe segmentation a challenging task. Also, false incomplete fissures and occurrence of diseases add to the complications of fissure detection. In this paper, we propose a semi-automated fissure segmentation algorithm using a minimal path approach on CT images. An energy function is defined such that the path integral over the fissure is the global minimum. Based on a few user defined points on a single slice of the CT image, the proposed algorithm minimizes a 2D energy function on the sagital slice computed using (a) intensity (b) distance of the vasculature, (c) curvature in 2D, (d) continuity in 3D. The fissure is the infimum energy path between a representative point on the fissure and nearest lung boundary point in this energy domain. The algorithm has been tested on 10 CT volume datasets acquired from GE scanners at multiple clinical sites. The datasets span through different pathological conditions and varying imaging artifacts.

  18. Fissure Integrity and Volume Reduction in Emphysema: A Retrospective Study.

    PubMed

    de Oliveira, Hugo Goulart; de Oliveira, Silvia Martins; Rambo, Rafael Ramos; de Macedo Neto, Amarilio Vieira

    2016-01-01

    One-way endobronchial valves (EBVs) relieve symptoms of emphysema, particularly in patients without collateral ventilation between the target and adjacent lobes. Pretreatment knowledge of fissure integrity could serve as an aid in indicating EBV interventions. This study aimed to investigate the relationship between software-measured lung fissure integrity and clinically relevant lung volume reduction (≥350 ml) in emphysema patients treated with one-way EBVs using a lobar exclusion strategy. Of 108 patients treated between March 2008 and July 2014, 38 had both baseline and follow-up computed tomography (CT) scans acquired following a specific protocol for quantitative CT analysis and were included in the study (total of 39 treatments, two lungs treated in 1 patient). Outcome measures were fissure integrity measured on baseline CT scans, difference between pre- and postoperative lung volume (considering the lowest measured postoperative volume), and correlation between fissure integrity and volume change. Fissure integrity ≥75% correlated with volume reduction ≥350 ml (Spearman coefficient: -0.65; p < 0.01). The mean and median volume reductions were 1,223.96 ± 907.5 ml and 663 ml, respectively, for lungs with fissure integrity ≥75% (n = 31). The accuracy of fissure integrity ≥75% in predicting a volume reduction was 87.2%. The positive predictive value of fissure integrity ≥75% to predict a volume reduction ≥350 ml was 83.9%, and it was 70% for fissure integrity 75-90% and 90.5% for fissure integrity >90%. A target lobe volume reduction using EBVs is possible with lung fissure integrity ≥75%. For patients with fissure integrity between 75 and 90%, a further evaluation of interlobar ventilation should be performed. A clinically relevant volume reduction following treatment with EBVs is likely with any level of fissure integrity >90%. © 2016 S. Karger AG, Basel.

  19. [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.

  20. Local thermal stimulation relaxes hypertonic anal sphincter: evidence of somatoanal reflex.

    PubMed

    Jiang, J K; Chiu, J H; Lin, J K

    1999-09-01

    Although it is generally believed that warm perineal baths reduce pain resulting from anal fissure, complicated hemorrhoids, or anal surgery, the exact mechanisms remain unclear. Because hypertonicity of the internal anal sphincter contributes to increasing pain in these conditions, it has been postulated that warm perineal baths could help to relax the anal sphincter, hence reducing pain. It is our purpose to demonstrate response of the anal sphincter to local thermal stimulation via a somatoanal reflex. Continuous anorectal manometry tracings were obtained from 15 healthy volunteers, 22 patients with hemorrhoid, and 20 patients with anal fissure. Local thermal stimulation was achieved by applying a heat pad on the right infragluteal region (local area), and subsequently on the right first interphalangeal region (control area). Obvious response to local thermal stimulation was shown by 13.3 percent of volunteers, 36.4 percent of patients with hemorrhoid, and 60 percent of patients with fissure. Heat-sensitive patients who responded to local thermal stimulation were divided to two groups, those with ultraslow waves and those without ultraslow waves. In patients with ultraslow waves, the amplitude of ultraslow waves decreased significantly after local thermal stimulation, with amplitude before local thermal stimulation, (mean +/- standard deviation) 66.2 +/- 30.6 mmHg, and during local thermal stimulation, 43.2 +/- 22.3 mmHg, respectively, P = 0.003. By contrast, in patients without ultraslow waves, the tonic pressure measured before local thermal stimulation and during local thermal stimulation was 74.2 +/- 23.5 and 60.5 +/- 18.5 mmHg, respectively, P = 0.001. The response began at approximately three minutes after local thermal stimulation when the skin temperature was 42.1 +/- 0.3 degrees C. No anal response was observed when the heat pad was applied to the control area. The maximum resting pressure of the heat-sensitive patients was significantly higher than

  1. 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.

  2. Sentinel lymph node metastasis in anal melanoma: a case report.

    PubMed

    Tien, Huey Y; McMasters, Kelly M; Edwards, Michael J; Chao, Celia

    2002-01-01

    Anal melanoma represents only 1% of all melanomas. Owing to delayed diagnosis and early metastasis, the prognosis is uniformly poor. Sentinel lymph node (SLN) biopsy has become the preferred method of nodal staging method for cutaneous melanoma. The role of SLN biopsy for staging of anal melanoma remains unclear. We report a 39-yr-old Caucasian woman who presented with a history of chronic hemorrhoidal pain. She noted a pedunculated peri-anal mass associated with bleeding. Upon biopsy, the lesion was found to be a 6-mm thick primary anal melanoma. There was no evidence of metastatic disease on preoperative imaging studies. She underwent wide local excision of the peri-anal site of the primary melanoma and intra-operative lymphatic mapping with both isosulfan blue and filtered technetium sulfur colloid. With the guidance a lymphoscintigram, ipsilateral inguinal sentinel lymphadenectomy identified five nodes, all of which were both "hot" and blue. One node was found to have a 1-mm metastatic deposit. Subsequently, the patient was treated with adjuvant radiation therapy to the primary site as well as to the superficial and deep inguinal nodal basins. She also received four cycles of biochemotherapy. SLN biopsy appears feasible for staging the superficial inguinal lymph nodes in patients with anal melanoma. However, the impact of SLN biopsy, early detection of occult metastasis, and adjuvant systemic and radiation therapy on the long-term survival of patients with anal melanoma is uncertain.

  3. [Fissure sealants--5 years of use].

    PubMed

    Azul, A M

    1990-01-01

    This study assesses the caries prevalence, retention and cost-effectiveness of a pit and fissure sealant in a children population with 622 cases, 5 years after a single application of an auto-polymerized sealant to permanent molars. The status of the sealant and the presence of caries or restaurations on the sealed teeth was assessed. In a self-controlled group of children, the prevalence of disease (caries and restaurations) was also assessed in non-sealed teeth, for comparison. The sealant application was compared with Class I-restauration with amalgam for cost-effectiveness analysis.

  4. 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.

  5. [Lichen simplex chronicus of the anal region and its differential diagnoses. A case series].

    PubMed

    Pleimes, M; Wiedemeyer, K; Hartschuh, W

    2009-11-01

    Lichen simplex chronicus (LSC) of the anal region is characterized by massive pruritus, constant itching and a chronic course. Histology is notable for a pseudoepitheliomatous hyperplasia. Correct diagnosis as well as therapy of anal LSC sometimes is difficult. Differential diagnostic considerations include verrucous lichen planus and squamous cell carcinoma. We present three cases and then summarize pathogenesis, diagnostics, differential diagnoses and therapeutic options for lichen simplex chronicus of the anal region.

  6. A Geophysical Study of Fissures in Pahrump, Nevada

    NASA Astrophysics Data System (ADS)

    Hirsch, A. C.; McEwan, M. J.; Howley, R. A.; Mehling, J. B.; Snelson, C. M.; Drohan, P.

    2004-12-01

    Earth fissures are surface expressions of deep fracturing subsidence systems caused by groundwater withdrawl greater than aquifer recharge. This type of subsidence is most common in arid environments of the south western U.S. such as, Las Vegas, NV, Phoenix, AZ, and areas in New Mexico. In addition, fissures have recently been identified in the Pahrump Valley in southwestern Nevada just west of Las Vegas. The city of Pahrump has experienced an increase in population and economic growth. This growth has lead to a higher demand in the use of the areas natural resources. One major concern is groundwater pumping and over-watering of the land surface. Pahrump has experienced significant differential subsidence within the valley causing significant structural damage to infrastructure. This differential subsidence is most readily identified by its surface expression as fissures. Earth fissures are not only shallow surface features but can be 10's of meters deep and 100's of meters long. These ground failures can be exacerbated by faults at depth, shallow bedrock, and/or differential compaction. However, the most significant cause is from groundwater withdrawl. Several geophysical methods were performed on the fissures to better understand their subsurface expression, trend, and ultimately their affect on the city of Pahrump. Seismic refraction, reflection, ground penetrating radar (GPR), and gravity measurements were performed on the fissures and surrounding area including local faults. Our initial studies show the fissures propagating for long distances, in a variety of shapes, and trending in a north-south direction. Initial GPR studies show high fissure reflections at approximately 1 and 1.5 meters along with general slumping features below these reflections. Fissures are an unmitigatable problem. Our results will help identify fissures in the area that do not have a surface expression as well as mapping the current fissures and their extent. These results can be used

  7. Anal cancer – a review

    PubMed Central

    Salati, Sajad Ahmad; Al Kadi, Azzam

    2012-01-01

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

  8. Surgical treatment of anal stenosis

    PubMed Central

    Brisinda, Giuseppe; Vanella, Serafino; Cadeddu, Federica; Marniga, Gaia; Mazzeo, Pasquale; Brandara, Francesco; Maria, Giorgio

    2009-01-01

    Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anaplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms. PMID:19399922

  9. Fine Mapping and Introgressing a Fissure Resistance Locus

    USDA-ARS?s Scientific Manuscript database

    Rice (Oryza sativa L.) kernel fissuring is a major concern of both rice producers and millers. Fissures are small cracks in rice kernels that increase breakage among kernels when transported or milled, which decrease the value of processed rice. This study employed molecular gene tagging methods to ...

  10. Seeded Amplification of Chronic Wasting Disease Prions in Nasal Brushings and Recto-anal Mucosa-Associated Lymphoid Tissues from Elk by Real-Time Quaking-Induced Conversion.

    PubMed

    Haley, Nicholas J; Siepker, Chris; Hoon-Hanks, Laura L; Mitchell, Gordon; Walter, W David; Manca, Matteo; Monello, Ryan J; Powers, Jenny G; Wild, Margaret A; Hoover, Edward A; Caughey, Byron; Richt, Jürgen A

    2016-04-01

    Chronic wasting disease (CWD), a transmissible spongiform encephalopathy of cervids, was first documented nearly 50 years ago in Colorado and Wyoming and has since been detected across North America and the Republic of Korea. The expansion of this disease makes the development of sensitive diagnostic assays and antemortem sampling techniques crucial for the mitigation of its spread; this is especially true in cases of relocation/reintroduction or prevalence studies of large or protected herds, where depopulation may be contraindicated. This study evaluated the sensitivity of the real-time quaking-induced conversion (RT-QuIC) assay of recto-anal mucosa-associated lymphoid tissue (RAMALT) biopsy specimens and nasal brushings collected antemortem. These findings were compared to results of immunohistochemistry (IHC) analysis of ante- and postmortem samples. RAMALT samples were collected from populations of farmed and free-ranging Rocky Mountain elk (Cervus elaphus nelsoni;n= 323), and nasal brush samples were collected from a subpopulation of these animals (n= 205). We hypothesized that the sensitivity of RT-QuIC would be comparable to that of IHC analysis of RAMALT and would correspond to that of IHC analysis of postmortem tissues. We found RAMALT sensitivity (77.3%) to be highly correlative between RT-QuIC and IHC analysis. Sensitivity was lower when testing nasal brushings (34%), though both RAMALT and nasal brush test sensitivities were dependent on both thePRNPgenotype and disease progression determined by the obex score. These data suggest that RT-QuIC, like IHC analysis, is a relatively sensitive assay for detection of CWD prions in RAMALT biopsy specimens and, with further investigation, has potential for large-scale and rapid automated testing of antemortem samples for CWD.

  11. Seeded Amplification of Chronic Wasting Disease Prions in Nasal Brushings and Recto-anal Mucosa-Associated Lymphoid Tissues from Elk by Real-Time Quaking-Induced Conversion

    PubMed Central

    Siepker, Chris; Hoon-Hanks, Laura L.; Mitchell, Gordon; Walter, W. David; Manca, Matteo; Monello, Ryan J.; Powers, Jenny G.; Wild, Margaret A.; Hoover, Edward A.; Caughey, Byron; Richt, Jürgen A.

    2016-01-01

    Chronic wasting disease (CWD), a transmissible spongiform encephalopathy of cervids, was first documented nearly 50 years ago in Colorado and Wyoming and has since been detected across North America and the Republic of Korea. The expansion of this disease makes the development of sensitive diagnostic assays and antemortem sampling techniques crucial for the mitigation of its spread; this is especially true in cases of relocation/reintroduction or prevalence studies of large or protected herds, where depopulation may be contraindicated. This study evaluated the sensitivity of the real-time quaking-induced conversion (RT-QuIC) assay of recto-anal mucosa-associated lymphoid tissue (RAMALT) biopsy specimens and nasal brushings collected antemortem. These findings were compared to results of immunohistochemistry (IHC) analysis of ante- and postmortem samples. RAMALT samples were collected from populations of farmed and free-ranging Rocky Mountain elk (Cervus elaphus nelsoni; n = 323), and nasal brush samples were collected from a subpopulation of these animals (n = 205). We hypothesized that the sensitivity of RT-QuIC would be comparable to that of IHC analysis of RAMALT and would correspond to that of IHC analysis of postmortem tissues. We found RAMALT sensitivity (77.3%) to be highly correlative between RT-QuIC and IHC analysis. Sensitivity was lower when testing nasal brushings (34%), though both RAMALT and nasal brush test sensitivities were dependent on both the PRNP genotype and disease progression determined by the obex score. These data suggest that RT-QuIC, like IHC analysis, is a relatively sensitive assay for detection of CWD prions in RAMALT biopsy specimens and, with further investigation, has potential for large-scale and rapid automated testing of antemortem samples for CWD. PMID:26888899

  12. Tongue fissure extraction and classification using hyperspectral imaging technology.

    PubMed

    Li, Qingli; Wang, Yiting; Liu, Hongying; Sun, Zhen; Liu, Zhi

    2010-04-10

    Tongue fissures, an important feature on the tongue surface, may be pathologically related to some diseases. Most existing tongue fissure extraction methods use tongue images captured by traditional charge coupled device cameras. However, these conventional methods cannot be used for an accurate analysis of the tongue surface due to limited information from the images. To solve this, a hyperspectral tongue imager is used to capture tongue images instead of a digital camera. New algorithms for automatic tongue fissure extraction and classification, based on hyperspectral images, are presented. Both spectral and spatial information of the tongue surface is used to segment the tongue body and extract tongue fissures. Then a classification algorithm based on a hidden Markov model is used to classify tongue fissures into 12 typical categories. Results of the experiment show that the new method has good performance in terms of the classification rates of correctness.

  13. The formation and extent of earth fissure in Shuangbutou, Beijing

    NASA Astrophysics Data System (ADS)

    Zhang, Youquan; Wu, Xun; Ren, Fangwei; Fu, Dequan; Wang, Rong; Wang, Haigang

    2017-04-01

    A 8.6-km-long earth fissure began to form in 2013 and currently affect the area in eastern Beijing plain. This earth fissure represent a potential threat to the groundwater that sustains growth in new downtown area of Beijing. An integrated survey program, including InSAR, hydrogeophysic survey and trenching, has been condected to investigate the formation and extent of the fissure. This work has allowed us to understand the processes and characterize earth fissure. InSAR result indicate the fissure in subsidence profiles occur near the part of the profile where its curvature is greatest and it is convex upward. The trenches demonstrated that the physical characteristics of this earth fissure isn't typical of similar fissures that formed in Northwest sites as a result of neotectonic activity. The ERT results across the fault suggest that the fault doesn't cut througth the whole quaternary strata and subsurface fault-associated depth was restricted to 27-43m. The occurrence and the development of the earth fissure closely parallel the pre-existing Medio-Pleistocene fault (Nanyuan-Tongxian fault) and initiated in the fault zone close to the footwall. The fissure originates within the unsaturated clayed strata at a relatively shallow depth and show a tensile failure with negligible vertical offset. The results of hydrogeophysical method and trench indicate that it migrates downward and terminate near the saturated-unsaturated interface. The survey results suggest the tensile-induced fissure was mainly caused by groundwater-level decline rather than natural tectonism.

  14. Screening for Anal Cancer in Women

    PubMed Central

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

    2015-01-01

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

  15. 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

  16. 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, ...

  17. [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.

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

    PubMed

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

    2014-01-01

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

  19. Effect of air abrasion and polishing on primary molar fissures.

    PubMed

    Lenzi, T L; Menezes, L B R; Soares, F Z M; Rocha, R O

    2013-04-01

    To evaluate the effect of air abrasion and polishing on primary molar fissures under light microscopy. 15 exfoliated primary second molars were longitudinally sectioned and photographed under a stereomicroscope (40×; baseline evaluation). Sections were then randomly allocated into one of the two groups (n = 15) and treated by either air abrasion (aluminium oxide jet) or air polishing (sodium bicarbonate jet) for 30 s. After treatment, sections were washed with an air/water spray, dried with absorbent paper, and photographed as previously described (final evaluation). Baseline and final morphology were compared by two blinded examiners who evaluated changes in the width and depth of fissures. The percentage of changed fissures was analysed, and the two treatments were compared using the Mann-Whitney test (α = 0.01). Both air systems resulted in fissure changes in most (93.3 %) of the sections. No significant differences in fissure width changes were found between treatments, but when changes in fissure depth were evaluated, air polishing was found to be less damaging than air abrasion (p < 0.01). Air abrasion and polishing cause changes to the anatomical configuration of occlusal fissures of primary molars.

  20. [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.

  1. [Differential diagnosis of anal eczema].

    PubMed

    Dietrich, A; Ruzicka, T; Hermans, C

    2015-06-01

    Dermatologic disorders often show involvement of the (peri)anal skin. However, diagnosis of (peri)anal dermatoses is often difficult even for experienced dermatologists due to delayed clinical presentation or prior treatment with over-the-counter medications. The distinct anatomical conditions of the (peri)anal region results in atypical clinical presentation of common dermatoses. Typical symptoms include pruritus, burning, bleeding and pain. Careful history of symptoms, stool, hygiene, sexual practice as well as thorough inspection of the entire body and proctological examination are crucial to make the correct diagnosis. In case of atypical presentation or uncertainty a biopsy needs to be obtained to ensure correct diagnosis and treatment.

  2. Patient Symptomatology in Anal Dysplasia.

    PubMed

    Hicks, Caitlin W; Wick, Elizabeth C; Leeds, Ira L; Efron, Jonathan E; Gearhart, Susan L; Safar, Bashar; Fang, Sandy H

    2015-06-01

    High-resolution anoscopy (HRA) is becoming increasingly advocated as a method of screening for anal dysplasia in high-risk patients. To describe, through HRA findings, the association between patient symptomatology and anal dysplasia among patients at high risk for anal dysplasia. Univariable and multivariable analyses were conducted of data from a prospectively maintained HRA database on all patients undergoing HRA with biopsy from November 1, 2011, to March 13, 2014, at a tertiary care HRA clinic. Data included demographics, medical history and comorbidities, HIV status and related measures (CD4 cell counts, HIV viral load, and use of highly active antiretroviral therapy), sexual orientation (when available), patient symptoms at initial presentation, physical examination findings, anal Papanicolaou (Pap) smear findings. High-resolution anoscopy diagnosis of high- vs low-grade dysplasia or no dysplasia. One hundred sixty-one HRA biopsy specimens (mean [SEM], 1.77 [0.11] biopsy specimens per patient) were obtained from 91 patients (mean [SEM] age, 45.7 [1.2] years; 61 men [67%]; 47 black patients [52%]; and 70 human immunodeficiency virus-positive patients [77%]). Twenty-seven patients (30%) had high-grade dysplasia, 26 had low-grade dysplasia (29%), and 38 had no dysplasia (42%). The majority of patients (63 [69%]) were asymptomatic (anal pain, 11 [12%]; bleeding, 14 [15%]; and pruritus, 10 [11%]). Forty-one patients (45%) presented with anal pain (odds ratio, 5.25; 95% CI, 1.44-21.82; P = .02), and patients with either high- or low-grade dysplasia were more likely to present with anal lesions on physical examination compared with patients without dysplasia (odds ratio, 4.34; 95% CI, 1.78-11.20; P = .002). Multivariable analysis suggested that anal pain was independently associated with high-grade dysplasia (odds ratio, 6.42; 95% CI, 1.18-43.3; P = .03). Anal dysplasia is a silent disease that is frequently asymptomatic. However, patients with anal

  3. Pit and fissure sealants or fluoride varnishes?

    PubMed

    Paglia, L

    2016-09-01

    Despite the general advances in dental care, dental caries is still a global health problem affecting many children. Occlusal surfaces of first permanent molars are the most susceptible sites in the developing permanent dentition. Dentists should use sealants or fluoride varnish - as well as other means - to limit the onset of tooth decay. Application of sealants is a recommended procedure to prevent or control caries. Sealing occlusal surfaces of newly erupted permanent molars in children and teenagers delays caries onset up to 48 months compared with unsealed teeth. However longer follow-ups shows a reduction of the preventive effect [Tikhonova et al., 2015]. A review of 2013 pointed out how sealants are effective in high risk children, however information about the benefits of sealing in other conditions is still scant [Ahovuo-Saloranta et al., 2013]. Fluoride varnishes are frequently used to prevent early childhood caries and reduce caries increment in very young children [Weintraub et al., 2006] and in the most vulnerable populations, where the prevalence of caries is higher and specialist visits are occasional [Chu et al., 2010]. Many studies have reported the effectiveness of different types and forms of fluoride agents in preventing dental caries among children and adolescents [Divaris et al., 2013]. A review clarifies that professional application of a 5% sodium fluoride varnish leads to remineralisation of early enamel caries in children. Solutions of 38% silver diamine fluoride are effective in arresting active dentine caries [Gao et al., 2016]. The last systematic review [Ahovuo-Saloranta et al., 2016], comparing pit and fissure sealants with fluoride varnishes explains that the pooled estimate slightly favours resin sealants over fluoride varnishes at two years. At four and nine years, the only comparative study (with high drop-out rates) found more caries on fluoride-varnished occlusal surfaces than on resin-sealed surfaces. There is evidence

  4. Prevalence of incomplete interlobar fissures of the lung.

    PubMed

    Sedlackova, Zuzana; Ctvrtlik, Filip; Miroslav, Herman

    2016-12-01

    Some patients benefit from accurate integrity assessment of pulmonary fissures. There are a number of methods for the assessment of incomplete interlobar fissures: imaging techniques, endobronchial methods measuring collateral air flow, a perioperative view, and autopsies used in research into pulmonary anatomy. We performed a computerized advanced search for primary evidence in the PubMed (Public/Publisher MEDLINE) and Google Scholar electronic databases using the following terms: incomplete and fissure. The search was not restricted to the English literature, nor limited by publication time. The bibliographic search was then extended to the "Related Articles" links and to the list of literature references of each article. Publications have consistently shown that interlobar fissures exhibit high variability and that preoperative or at least detailed perioperative assessment can influence the effect of treatment.

  5. Implications of ground-deformation measurements across earth fissures in subsidence areas in the southwestern USA

    USGS Publications Warehouse

    Holzer, Thomas L.

    2010-01-01

    Ground deformation was monitored at earth fissures in areas of land subsidence induced by groundwater extraction in the southwestern United States. The ground deformation is consistent with the mechanism that fissures are caused by horizontal strains generated by bending of overburden in response to localized differential compaction. Subsidence profiles indicated that localized differential subsidence occurred across the fissures and that maximum convex-upward curvature was at the fissure. The overall shape of the profile stayed similar with time, and maximum curvature remained stationary at the fissure. Horizontal displacements were largest near the fissure, and generally were small to negligible away from the fissure. Maximum tensile horizontal strains were at the fissure and coincided with maximum curvature in the subsidence profiles. Horizontal tensile strain continued to accumulate at fissures after they formed with rates of opening ranging from 30 to 120 microstrain/year at fissures in Arizona.

  6. Electrocautery for Precancerous Anal Lesions

    Cancer.gov

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

  7. Hardness testing of some fissure-sealing materials.

    PubMed

    Ulvestad, H

    1977-11-01

    The mechanical properties of fissure-sealing materials are of significant importance for their durability, i.e. their wear resistance. One of the methods of evaluating a material's resistance to attrition is to apply a hardness test. In the present investigation, the surface hardness of some fissure-sealing materials was tested. Sealants made from diluted composite materials and with inclusion of inorganic filler particles appeared to have a considerable higher surface hardness than the other sealing materials tested.

  8. Differential compaction mechanism for earth fissures near Casa Grande, Arizona.

    USGS Publications Warehouse

    Jachens, R.C.; Holzer, T.L.

    1982-01-01

    Precise gravity measurements indicate that earth fissures or tension cracks caused by ground-water withdrawal within a 10km2 area SE of Casa Grande are associated with relief on the buried interface between the alluvial aquifer and underlying bedrock. These relations suggest that the fissures are forming in response to localized differential compaction caused by localized variations of aquifer-system thickness. -from Authors

  9. Modern management of anal fistula

    PubMed Central

    Limura, Elsa; Giordano, Pasquale

    2015-01-01

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

  10. 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

  11. Randomized trial on fluorides and sealants for fissure caries prevention.

    PubMed

    Liu, B Y; Lo, E C M; Chu, C H; Lin, H C

    2012-08-01

    To investigate the effectiveness of topical fluorides in preventing fissure caries, we conducted a randomized controlled trial with parallel groups. In total, 501 children (1,539 molars, 3,078 sites), mean age 9.1 years, who had at least one sound permanent first molar with deep fissures or fissures with signs of early caries were recruited. They were randomly allocated among four groups: (1) resin sealant, single placement; (2) 5% NaF varnish, semi-annual application; (3) 38% silver diamine fluoride (SDF) solution, annual application; and (4) placebo control. Follow-up examinations were conducted every 6 months by a masked examiner. After 24 months, 485 children (97%) were examined. Proportions of pit/fissure sites with dentin caries in the sealant, NaF, SDF, and control groups were 1.6%, 2.4%, 2.2%, and 4.6%, respectively. A multi-level logistic regression analysis accounting for the effects of data clustering and confounding factors showed that fissures in any of the three treatment groups had significantly lower risks of carious cavity development into dentin than did controls (p < 0.05). We concluded that placement of resin sealant, semi-annual application of NaF varnish, and annual application of SDF solution are all effective in preventing pit and fissure caries in permanent molars (ClinicalTrials.gov number CT01446107).

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

    PubMed

    Connolly, C; Tierney, S; Grace, P

    2017-09-13

    Nitric oxide (NO) has diverse roles as a biological messenger. [1] Topically applied nitrate donors cause relaxation of the internal anal sphincter (IAS) and facilitate healing of anal fissures [2,3]. Systemic nitrates are commonly used for the treatment of ischaemic heart disease, yet the effects of systemically administered nitrates on the smooth muscle of the IAS are unknown. Our aim was to test the hypothesis that systemically administered nitrates at a normal dose, cause inhibition of anal sphincter activity. With fully informed consent, anal manometry was performed on nine volunteers. Maximum and mean anal resting pressure (representing the IAS), maximum squeeze pressure (representing the external anal sphincter), heart rate and blood pressure were measured, before and after administration of a normal 400 μg dose of sublingual glyceryl trinitrate spray. Data are expressed as mean (± standard error of the mean (SEM)). In four females and five males ranging from 19 to 50 years of age, administration of GTN resulted in a significant reduction in systolic blood pressure from 138 ± 5 to 127 ± 4 mmHg, P < 0.01. Mean resting pressure, over 5 min, was significantly reduced from 70 ± 10 to 62 ± 10 mmHg P < 0.05. The maximum resting pressure was also significantly reduced from 109 ± 12 to 86 ± 10 mmHg P = 0.04. Maximum squeeze pressure, heart rate and diastolic blood pressure were not significantly reduced. Systemic nitrates significantly inhibit internal anal sphincter function.

  13. Synchronized functional anal sphincter assessment: maximizing the potential of anal vector manometry and 3-D anal endosonography.

    PubMed

    Schizas, A M P; Ahmad, A N; Emmanuel, A V; Williams, A B

    2016-07-01

    Understanding the association between structure and function is vital before considering surgery involving anal sphincter division. By correlating three-dimensional anal endosonography (AES) and three-dimensional anal canal vector volume manometry (VVM), this study details a method to produce measurements of both sphincter length and pressure leading to identification of the functionally important areas of the anal canal. The aim of this study was to provide combined detailed information on anal canal anatomy and physiology. Twelve males and 12 nulliparous females with no bowel symptoms underwent VVM (using a water-perfused, eight-channel radially arranged catheter) and AES. The synchronization of AES and VVM identified that the majority of rest and squeeze anal pressure is present in the portion of the anal canal covered by both anal sphincters. Nearly, 20% of overall resting anal pressure is produced distal to the caudal termination of the internal anal sphincter. Puborectalis accounts for a significantly greater percentage volume of pressure in females both at rest and when squeezing, though the total volume of pressure is not significantly greater. The majority of resting and squeezing pressure and the least asymmetry, in both sexes, is in the portion of the anal canal covered by external anal sphincter. In females, the external anal sphincter is shorter and a proportionately longer puborectalis accounts for a greater percentage of pressure. Sphincter targeted fistula surgery in females must be performed with special caution. A protective role for puborectalis following obstetric anal sphincter injury is suggested. © 2016 John Wiley & Sons Ltd.

  14. Pathogenesis and persistence of cryptoglandular anal fistula: a systematic review.

    PubMed

    Sugrue, Jeremy; Nordenstam, Johan; Abcarian, Herand; Bartholomew, Amelia; Schwartz, Joel L; Mellgren, Anders; Tozer, Philip J

    2017-06-01

    Anal fistulas continue to be a problem for patients and surgeons alike despite scientific advances. While patient and anatomical characteristics are important to surgeons who are evaluating patients with anal fistulas, their development and persistence likely involves a multifaceted interaction of histological, microbiological, and molecular factors. Histological studies have shown that anal fistulas are variably epithelialized and are surrounded by dense collagen tissue with pockets of inflammatory cells. Yet, it remains unknown if or how histological differences impact fistula healing. The presence of a perianal abscess that contains gut flora commonly leads to the development of anal fistula. This implies a microbiological component, but bacteria are infrequently found in chronic fistulas. Recent work has shown an increased expression of proinflammatory cytokines and epithelial to mesenchymal cell transition in both cryptoglandular and Crohn's perianal fistulas. This suggests that molecular mechanisms may also play a role in both fistula development and persistence. The aim of this study was to examine the histological, microbiological, molecular, and host factors that contribute to the development and persistence of anal fistulas.

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

    PubMed

    2007-01-01

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

  16. Preservation of anal function after total excision of the anal mucosa for Bowen's disease.

    PubMed Central

    Reynolds, V H; Madden, J J; Franklin, J D; Burnett, L S; Jones, H W; Lynch, J B

    1984-01-01

    Six women with Bowen's disease of the anogenital area were treated by total excision of the anal mucosa, perianal skin and, in some cases, partial vulvectomy. Two patients had foci of microinvasive squamous carcinoma. Adequate tumor margins were determined by frozen sections. The resulting mucosal and cutaneous defects were grafted with medium split-thickness skin grafts applied to the anal canal and sutured circumferentially to the rectal mucosa. Grafts were held in place by a finger cot inserted in the anal canal and stuffed with cotton balls. Patients were constipated five or six days with codeine. The skin grafts healed per primam. One additional patient was similarly treated for a chronic herpetic ulceration of the anus and healed. Contrary to dire predictions, all patients were able to distinguish between gaseous and solid rectal contents and sphincter function was preserved. In one patient, Bowen's disease has recurred in the grafted perianal skin. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:6372711

  17. Laser fluorescence detection of demineralization in artificial occlusal fissures.

    PubMed

    Ferreira Zandoná, A G; Analoui, M; Schemehorn, B R; Eckert, G J; Stookey, G K

    1998-01-01

    Laser fluorescence (LF) has been used previously to detect early smooth-surface lesions. Although its use for detection of occlusal demineralization has been implicated, it has not been demonstrated. The aim of this study was to determine whether LF could detect demineralization in the base of artificial fissures. To employ LF for detection of occlusal demineralization an apparatus was devised to direct laser light into fissures and simultaneously detect fluorescence from the base of the fissures. Three groups (n = 40/group) of differing fissure types were prepared (straight wall, converging and diverging wall) with either a sound or lesioned base. One half of each group was examined with LF and dye-enhanced LF (DELF); the other half was examined with LF, exposed to plaque, examined with LF and DELF, air-polished and examined with DELF. All images were scored twice as either (1) carious; (2) sound, or (3) undetermined, by a group of 3 examiners. For fissures without plaque, the average sensitivity was higher for DELF (0.76) than for LF (0.54) (p < 0.05). Likewise, the average specificity was higher for DELF (0.64) than for LF (0.29) (p < 0.05). In the presence of plaque, sensitivity was higher for DELF (0.91) compared to LF (0.43); however, specificity was lower for DELF (0.05) compared to LF (0.55). When the fissures were air-polished and then examined with DELF, sensitivity averaged 0.82 (p < 0.05), and specificity increased consistently (average 0.51, p < 0.05). It was concluded that, in the absence of plaque, DELF was a better diagnostic tool than LF for detection of demineralization in artificial fissures.

  18. Internal anal sphincter: Clinical perspective.

    PubMed

    Kumar, Lalit; Emmanuel, Anton

    2017-08-01

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

  19. Primary radiation therapy in the treatment of anal carcinoma

    SciTech Connect

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

    1983-09-01

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

  20. Acceptability of fissure sealants from the child's perspective.

    PubMed

    Morgan, A G; Madahar, A K; Deery, C

    2014-07-11

    To seek children's opinions about the acceptability of resin fissure sealant placement. Service evaluation using a child-centred questionnaire issued to a prospective sample of consecutive hospital patients.Method Questionnaires were issued to children, aged 3 to 16 years, immediately after resin fissure sealant placement in the Paediatric Dentistry Department in Sheffield. Participants used a three-point faces scale for positive, neutral and negative responses, arranged as a Likert scale with minimal text, to rate their treatment experiences and satisfaction with the dental visit. Two hundred questionnaires were returned. Overall, 96% (n = 191) recorded a positive or neutral response for the ease at which they coped with the procedure, with most children positive about having fissure sealants placed again (66%; n = 132). Further analysis demonstrated that children who had fissure sealants on a previous occasion found them easier than those having them for the first time (p <0.05, chi-squared test). Almost half of all participants where ambivalent about the taste and feeling (46%; n = 92 and 55%; n = 110 respectively). The vast majority of children were satisfied with the explanations provided by their operator. Most participants found having resin fissure sealants placed an overall acceptable procedure, with patient acceptance improving with increased treatment experience.

  1. Open Fissure Folds record coseismic loading and postseismic stress relaxation

    NASA Astrophysics Data System (ADS)

    Nüchter, Jens-Alexander

    2015-03-01

    Open Fissure Folds hosted by high pressure/low temperature metamorphic rocks of south Evia (Greece) are introduced, their structural and microstructural record is analysed, and a mechanical model is proposed. Open Fissure Folds are preserved as at least two parallel folded quartz-feldspar veins separated by narrow buckled rock columns. The veins originated as tensile cracks that propagated in the middle crust driven by high differential stress. Features diagnostic for Open Fissure Folds indicate that the rock columns represented the layers of high viscosity, and not the veins as consistently reported in many previous studies on folded veins. This record is taken to indicate that buckling of the rock columns initiated after arrest of the fractures and terminated prior to complete vein sealing. Accordingly, mechanical decoupling by open fissures allowed for buckling of the rock columns in response to episodic creep of the host rocks according to stress relaxation, as expected for postseismic deformation in the earthquake cycle. I propose that the parental fractures propagated in response to quasi-instantaneous coseismic loading of the middle crust. Buckling was attributed to transient postseismic creep and stress relaxation. Complete sealing of the veins occurred when stresses were largely relaxed. Each Open Fissure Fold records the stress and strain history of a single earthquake.

  2. Shape analysis of human brain interhemispheric fissure bending in MRI.

    PubMed

    Zhao, Lu; Hietala, Jarmo; Tohka, Jussi

    2009-01-01

    This paper introduces a novel approach to analyze Yakovlevian torque by quantifying the bending of human brain interhemispheric fissure in three-dimensional magnetic resonance imaging. It extracts the longitudinal medial surface between the cerebral hemispheres, which are segmented with an accurate and completely automatic technique, as the shape representation of the interhemispheric fissure. The extracted medial surface is modeled with a polynomial surface through least-square fitting. Finally, curvature features, e.g., principal, Gaussian and mean curvatures, are computed at each point of the fitted medial surface to describe the local bending of the interhemispheric fissure. This method was applied to clinical images of healthy controls (12 males, 7 females) and never-medicated schizophrenic subjects (11 males, 7 females). The hypothesis of the normal interhemispheric fissure bending (rightward in the occipital region) was quantitatively demonstrated. Moreover, we found significant differences (p < 0.05) between the male schizophrenics and healthy controls with respect to the interhemispheric fissure bending in the frontal and occipital regions. These results show that our method is applicable for studying abnormal Yakovlevian torque related to mental diseases.

  3. 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

  4. 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. 

  5. Marginal Microleakage of Conventional Fissure Sealants and Self-Adhering Flowable Composite as Fissure Sealant in Permanent Teeth

    PubMed Central

    Rahimian-Imam, Sara; Fayazi, Mohammad Reza

    2015-01-01

    Objectives: Application of sealants is a safe and effective way to prevent occlusal caries in the posterior teeth. A successful sealant therapy depends on good isolation. Decreased steps of adhesive application may enable proper isolation and use of self-adhering flowable composites for sealant therapy. This study sought to compare the marginal microleakage of fissure sealants and self-adhering flowable composites in permanent teeth. Materials and Methods: This in vitro, experimental study was conducted on 60 extracted human premolar teeth. The teeth were divided randomly into two groups of 30. In the first group, fissure sealant (Clinpro, 3M ESPE, USA) was placed on the teeth. In the second group, self-adhering flowable composite (Vertise Flow, Kerr, USA) was applied as the sealant. Then, both groups were immersed in 0.5% fuchsin dye solution for 24 hours. Sectioned samples were observed with a stereomicroscope for the extent of dye penetration. Data were analyzed using SPSS 21 and the Mann-Whitney test (P<0.05). Results: Microleakage in the fissure sealant group was significantly higher than that in the self-adhering flowable composite group (P<0.001). Conclusion: Microleakage was less using self-adhering flowable composite compared to conventional fissure sealant; therefore, self-adhering flowable composite can be used as a suitable fissure sealant in permanent teeth. PMID:26884777

  6. Engineering a robotic approach to mapping exposed volcanic fissures

    NASA Astrophysics Data System (ADS)

    Parcheta, C. E.; Parness, A.; Mitchell, K. L.

    2014-12-01

    Field geology provides a framework for advanced computer models and theoretical calculations of volcanic systems. Some field terrains, though, are poorly preserved or accessible, making documentation, quantification, and investigation impossible. Over 200 volcanologists at the 2012 Kona Chapman Conference on volcanology agreed that and important step forward in the field over the next 100 years should address the realistic size and shape of volcanic conduits. The 1969 Mauna Ulu eruption of Kīlauea provides a unique opportunity to document volcanic fissure conduits, thus, we have an ideal location to begin addressing this topic and provide data on these geometries. Exposed fissures can be mapped with robotics using machine vision. In order to test the hypothesis that fissures have irregularities with depth that will influence their fluid dynamical behavior, we must first map the fissure vents and shallow conduit to deci- or centimeter scale. We have designed, constructed, and field-tested the first version of a robotic device that will image an exposed volcanic fissure in three dimensions. The design phase included three steps: 1) create the payload harness and protective shell to prevent damage to the electronics and robot, 2) construct a circuit board to have the electronics communicate with a surface-based computer, and 3) prototype wheel shapes that can handle a variety of volcanic rock textures. The robot's mechanical parts were built using 3d printing, milling, casting and laser cutting techniques, and the electronics were assembled from off the shelf components. The testing phase took place at Mauna Ulu, Kīlauea, Hawai'i, from May 5 - 9, 2014. Many valuable design lessons were learned during the week, and the first ever 3D map from inside a volcanic fissure were successfully collected. Three vents had between 25% and 95% of their internal surfaces imaged. A fourth location, a non-eruptive crack (possibly a fault line) had two transects imaging the textures

  7. 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

  8. Anal sphincter trauma and anal incontinence in urogynecological patients.

    PubMed

    Guzmán Rojas, R A; Kamisan Atan, I; Shek, K L; Dietz, H P

    2015-09-01

    To determine the prevalence of evidence of residual obstetric anal sphincter injury, to evaluate its association with anal incontinence (AI) and to establish minimal diagnostic criteria for significant (residual) external anal sphincter (EAS) trauma. This was a retrospective analysis of ultrasound volume datasets of 501 patients attending a tertiary urogynecological unit. All patients underwent a standardized interview including determination of St Mark's score for those presenting with AI. Tomographic ultrasound imaging (TUI) was used to evaluate the EAS and the internal anal sphincter (IAS). Among a total of 501 women, significant EAS and IAS defects were found in 88 and 59, respectively, and AI was reported by 69 (14%). Optimal prediction of AI was achieved using a model that included four abnormal slices of the EAS on TUI. IAS defects were found to be less likely to be associated with AI. In a multivariable model controlling for age and IAS trauma, the presence of at least four abnormal slices gave an 18-fold (95% CI, 9-36; P < 0.0001) increase in the likelihood of AI, compared with those with fewer than four abnormal slices. Using receiver-operating characteristics curve statistics, this model yielded an area under the curve of 0.86 (95% CI, 0.80-0.92). Both AI and significant EAS trauma are common in patients attending urogynecological units, and are strongly associated with each other. Abnormalities of the IAS seem to be less important in predicting AI. Our data support the practice of using, as a minimal criterion, defects present in four of the six slices on TUI for the diagnosis of significant EAS trauma. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  9. Selection for fissure resistance now made possible in early breeding generations

    USDA-ARS?s Scientific Manuscript database

    Rice kernel fissuring is one of the leading causes of milling yield losses. Any reduction in fissuring can result in direct increases in yield and profit for both producers and millers. While most U.S. rice varieties yield around 55% head rice, the fissure-resistant varieties ‘Cypress’, ‘Saber’ an...

  10. New method opens opportunity to proactively select for fissure resistance in early breeding generations

    USDA-ARS?s Scientific Manuscript database

    WANTED: New rice varieties improved for resistance to kernel fissuring. Rice kernel fissuring is one of the leading causes of reduced milling yield. Any reduction in fissuring can result in direct increases in yield and profit for both producers and millers. While most U.S. rice varieties yield a...

  11. Investigation of the subsurface geometry of fissure-ridge travertine with GPR, Pamukkale, western Turkey

    NASA Astrophysics Data System (ADS)

    Çaǧlar Yalçiner, Cahit

    2013-06-01

    Cracks in the upper crust are the result of either local or regional tectonic stress. Such structural elements are conduits for fluids in the crust. In Pamukkale, hot water which is rich in calcium carbonate emerges from fissures. The hot water issuing from the fissures precipitates travertine both in the fissures and on the surface. As a result, a ridge, which is called fissure-ridge travertine, forms along the central fissure. Fissure-ridge travertines are lens-shaped at the surface. Since fissure-ridge travertines are of great tectonic significance, their surface characteristics have been studied in detail. However, the subsurface geometry of travertine ridges is not well known. GPR was used to examine the subsurface geometry of fissure-ridge travertine and the central fissure. GPR profiles were combined across the ridge to produce a three-dimensional (3D) subsurface image of the travertine mass. The 3D image showed that the thickness and width of the travertine mass are at a maximum near the centre of the ridge and they both decrease asymmetrically towards the ends. Perpendicular GPR slices across the central fissure showed that the thickness of the vertically banded fissure-travertine increases with depth. 3D modelling suggests that the lateral propagation of the central fissure is asymmetric.

  12. Dental Pit and Fissure Sealants: Implications for School Health Personnel.

    ERIC Educational Resources Information Center

    McCormack-Brown, K. R.; And Others

    1989-01-01

    To promote good personal hygiene practices in students, school health personnel must be informed about dental pit and fissure sealants and related programs. Adoption and maintenance of such programs may depend on the success of school health personnel in educating administrators and policymakers. (SM)

  13. Flow characteristics and sealing ability of fissure sealants.

    PubMed

    Barnes, D M; Kihn, P; von Fraunhofer, J A; Elsabach, A

    2000-01-01

    This study evaluated the relationship between fissure sealant viscosity, leakage prevention and the incidence of void formation of five commercially available pit-and-fissure sealants. Seventy-two intact, caries free human pre-molars and molars were divided into six test groups of 12 teeth each. All teeth were cleaned with a flour of pumice prophylaxis followed by etching for 60 seconds with 37% H3PO4, rinsing for 30 seconds and drying with oil-free air. Five commercial, light-cured fissure sealants and an unfilled version of one sealant were applied following manufacturers' instructions. Teeth were thermal cycled for 5000 cycles from 5-50 degrees C with a one-minute dwell time at each temperature. Silver nitrate staining followed by mesiodistal sectioning was performed. Leakage and void formation were evaluated at X50 optical magnification. Viscosity was assessed by syringing the fissure sealants into short pipettes, allowing free flow for 30 seconds and then light curing for one minute. The length of unfilled capillary was measured with a Vernier gauge. All experimental data was subjected to a one-way ANOVA, and where differences were detected, they were identified by a post hoc Tukey hsd test at a priori alpha = 0.05. Based on the conditions of the study, viscosity and flow characteristics had no effect on sealing ability or void formation.

  14. Dental Pit and Fissure Sealants: Implications for School Health Personnel.

    ERIC Educational Resources Information Center

    McCormack-Brown, K. R.; And Others

    1989-01-01

    To promote good personal hygiene practices in students, school health personnel must be informed about dental pit and fissure sealants and related programs. Adoption and maintenance of such programs may depend on the success of school health personnel in educating administrators and policymakers. (SM)

  15. [Predictive factors of 2-month postpartum anal incontinence among patients with an obstetrical anal sphincter injury].

    PubMed

    Ménard, S; Poupon, C; Bourguignon, J; Théau, A; Goffinet, F; Le Ray, C

    2016-10-01

    To determine prevalence of short-term postpartum anal incontinence after obstetrical anal sphincter injury and prognostic factors. Retrospective study including every patient with an obstetrical anal sphincter injury between January 2006 and December 2012 in one tertiary maternity unit. Patients were interviewed and examined at 2-month postpartum. Anal incontinence was defined by the presence of at least one of the following symptoms: flatus incontinence, faecal incontinence and faecal urgency. Among 17,110 patients who delivered vaginally during period study, 134 (0.8%) presented an anal sphincter injury. Postpartum obstetrical data were available for 110 of them. Among those patients, 50 women (45.5%) had at least one symptom of anal incontinence at 2-month postpartum and 8 (7.3%) had faecal incontinence. Only maternal age and second stage duration were significantly associated with anal incontinence after obstetrical anal sphincter injury. The degree of sphincter damage at delivery (IIIa, b, c, IV) was not associated with the risk of anal incontinence at 2-month postpartum. Maternal age and second stage duration were the only risk factor for anal incontinence after obstetrical anal sphincter injury in this study. High prevalence of anal incontinence at 2-month postpartum of obstetrical anal sphincter injury is observed no matter what is the degree of anal sphincter damage. Our results highlight the importance to diagnose all obstetrical anal sphincter injuries whatever the degree of damage. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

    PubMed

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

    2012-12-01

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

  17. Cellular resolution optical access to brain regions in fissures: imaging medial prefrontal cortex and grid cells in entorhinal cortex.

    PubMed

    Low, Ryan J; Gu, Yi; Tank, David W

    2014-12-30

    In vivo two-photon microscopy provides the foundation for an array of powerful techniques for optically measuring and perturbing neural circuits. However, challenging tissue properties and geometry have prevented high-resolution optical access to regions situated within deep fissures. These regions include the medial prefrontal and medial entorhinal cortex (mPFC and MEC), which are of broad scientific and clinical interest. Here, we present a method for in vivo, subcellular resolution optical access to the mPFC and MEC using microprisms inserted into the fissures. We chronically imaged the mPFC and MEC in mice running on a spherical treadmill, using two-photon laser-scanning microscopy and genetically encoded calcium indicators to measure network activity. In the MEC, we imaged grid cells, a widely studied cell type essential to memory and spatial information processing. These cells exhibited spatially modulated activity during navigation in a virtual reality environment. This method should be extendable to other brain regions situated within deep fissures, and opens up these regions for study at cellular resolution in behaving animals using a rapidly expanding palette of optical tools for perturbing and measuring network structure and function.

  18. The effect of vegetation on infiltration in shallow soils underlain by fissured bedrock

    NASA Astrophysics Data System (ADS)

    Stothoff, S. A.; Or, D.; Groeneveld, D. P.; Jones, S. B.

    1999-05-01

    Mean annual infiltration above the high-level waste repository proposed to be sited at Yucca Mountain, Nevada, has a large impact on assessments of repository performance. Ongoing investigations of infiltration processes have identified the relatively horizontal caprock environment above portions of the repository as a potentially large source of infiltrating waters, due to shallow, permeable soils above a moderately welded tuff with large soil-filled fissures. The combination of shallow soils and fissured bedrock allows rapid penetration of wetting pulses to below the rooting zone. Plant uptake can strongly reduce net infiltration in arid environments with high water storage capacity, and, despite the low water storage capacity, there is a relatively high vegetation density in this environment. The apparent discrepancy between high vegetation density and low water storage motivates the study of plant-hydrologic interactions in this semiarid environment. Field observations were coupled with plant- and landscape-scale models to provide insight into plant-hydrologic interactions. Several lines of evidence, including: (i) linear plant growth features observed on aerial photographs; (ii) comparisons of plant cover within the fissured environment and comparable environments lacking fissures; and (iii) direct excavations, all suggest that the widely spaced soil-filled fissures are conducive to plant growth even when fissures are buried at soil depths exceeding 30 cm. Results from a mechanistic simulation model for root growth into fissures suggest that the additional (sheltered) plant-available soil water within fissures provides a competitive advantage for plant establishment. Therefore, plants that germinate above a fissure are more likely to survive, in turn developing linear features above fissures. Having established that plants preferentially root within soil-filled fissures in the caprock environment, a set of simulations were performed to examine the hydrologic

  19. Fissure sealants: Knowledge and practice of Yemeni dental practitioners.

    PubMed

    Al-Maweri, Sadeq Ali; Al-Jamaei, Aisha Ahmed; Halboub, Esam Saleh; Al-Soneidar, Walid Ahmed; Tarakji, Bassel; Alsalhani, Anas

    2016-01-01

    This study was conducted to evaluate Yemeni dental practitioners' knowledge and practices concerning fissure sealants. A modified questionnaire consisted of 25-items was distributed to 500 dentists working in Sana'a City. Descriptive statistics and Chi-square/Fisher's exact tests were used for statistical analyses. The response rate was 74%. Most of the respondents were male (61.3%), general practitioners (84.2%), and had <5 years of clinical experience (48.3%). The respondents showed a reasonable level of knowledge about sealants, with the majority (88%) believed that there is strong scientific evidence about fissure sealants effectiveness and around 90% showed a good understanding of sealant placement instructions. On the other hand, respondents showed insufficient knowledge about sealants clinical practice. Although a high proportion of dental practitioners showed adequate knowledge about dental sealant, following guidelines and standardized procedures in clinical practice is lacking. These emphasize the need for regular continuing education courses for dental professional.

  20. Basaltic fissure eruptions, plume heights, and atmospheric aerosols

    NASA Technical Reports Server (NTRS)

    Stothers, R. B.; Wolff, J. A.; Self, S.; Rampino, M. R.

    1986-01-01

    Convective plumes that rise above Hawaiian-style fire fountains consist of volcanic gases, aerosols, fine ash, and entrained heated air. Plume theory has been applied to observational estimates of the rate of thermal energy release from large fire fountains. The theoretically predicted heights of maintained plumes agree very well with the heights found from actual observations. Predicted plume heights for both central-vent (point-source) and fissure (line-source) eruptions indicate a stratospheric penetration by plumes that form over vents with very high magma-production rates. Flood basalt fissure eruptions that produce individual lava flows with volumes greater than 100 cu km at very high mass eruption rates are capable of injecting large quantities of sulfate aerosols into the lower stratosphere, with potentially drastic short-term atmospheric consequences, like acid precipitation, darkening of the sky, and climatic cooling.

  1. [Cold or hot sitz baths in the emergency treatment of acute anal pain due to anorectal disease? Results of a randomised clinical trial].

    PubMed

    Maestre, Yolanda; Parés, David; Salvans, Silvia; Ibáñez-Zafón, Inés; Nve, Esther; Pons, Maria-José; Martínez-Casas, Isidro; Pascual, Marta; Pera, Miguel; Grande, Luis

    2010-08-01

    The popular belief advocates the use of sitz (sitting) baths with cold water for the treatment of acute anal pain, but clinical practice guides recommend the use of hot water for its known effect on the at-rest anal pressure. The objective of the study was to examine the analgesic effect on the quality of life, manometer data and clinical progress, of the two temperatures in sitz baths in patients with anal pain. A randomised clinical trial on patients with acute anal pain due to haemorrhoids or anal fissures, divided into Group 1: Sitz baths with water at a temperature of less than 15 degrees C, and Group 2: Baths with a water temperature above 30 degrees C. The analgesia was the same in both groups. An analysis was made of the pain at 7 days (visual analogue scale), quality of life (SF-36), anal at-rest pressure and disease progress. Of the 27 eligible patients, 24 were randomised (Group 1: n=12 y Group 2: n=12). There were no statistical differences in pain, but it remained stable in Group 1, but gradually decreased in the patients of Group 2, the difference being in the pain scores on the first day compared to the seventh in Group 2 (p=0.244). The rest of the variables were similar. There were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water. (ISRCTN Number: 50105150).

  2. Fluoride release and uptake abilities of different fissure sealants.

    PubMed

    Poggio, Claudio; Andenna, Gianluigi; Ceci, Matteo; Beltrami, Riccardo; Colombo, Marco; Cucca, Lucia

    2016-07-01

    The long-term capability of resin sealants and glass ionomer cements to release fluoride is associated to a reduction in pit and fissure caries. The regular use of fluoride varnishes/toothpastes can result in the absorption of fluoride into the sealant. The objective of the present study was to assess the fluoride release/uptake capacities of different fissure sealants. Three different fissure sealants (Fuji Triage/GC, Fissurit FX/Voco and Grandio Seal/Voco) were examined. Ten discs of each material were prepared. Each disc was incubated with distilled water and then the solution analyzed for diluted for fluoride concentration, using a combination of fluoride electrode (OrionGP 1 S/N 13824, Orion Research Inc, Boston, MA, USA) connected to an expandable ion analyzer (Orion 720A, Orion Research Inc, Boston, MA, USA). Standard curves between 1 and 100 ppm F- were used to calibrate the electrode. Cumulative fluoride release was measured on days 1, 2, 3, 5, 7, 21, 35 and 49, then two different fluoride varnishes/pastes (Profluorid Varnish/Voco, MI Paste Plus/GC), were applied to the sealants tested, and fluoride release (after reuptake) was measured on days 56, 70 and 84. Kruskal Wallis test confirmed significant differences in fluoride release between Fuji Triage/GC and Fissurit FX/Voco and Grandio Seal/Voco from day 1 (P < 0.001). The application of fluoride varnish Profluorid Varnish enhanced the fluoride release for all sealants (P < 0.05). MI Paste Plus enhanced the fluoride release for all sealants except for Fuji Triage/GC (P > 0.05). The GIC-based sealant (Fuji Triage/GC) released significantly more fluoride than the resin sealants tested. The exposure to the fluoridated varnish (Profluorid Varnish) significantly recharged the sealants tested more than the CPP-ACPF toothpaste (MI Paste Plus). Fissure sealants, fluoride release, fluoride uptake, glass ionomer cements.

  3. Injectabilite des coulis de ciment dans des milieux fissures

    NASA Astrophysics Data System (ADS)

    Mnif, Thameur

    Le travail presente ici est un bilan du travaux de recherche effectues sur l'injectabilite des coulis de ciment dans lu milieux fissures. Un certain nombre de coulis a base de ciment Portland et microfin ont ete selectionnes afin de caracteriser leur capacite a penetrer des milieux fissures. Une partie des essais a ete menee en laboratoire. L'etude rheologique des differents melanges a permis de tester l'influence de l'ajout de superplastifiant et/ou de fumee de silice sur la distribution granulometrique des coulis et par consequent sur leur capacite a injecter des colonnes de sable simulant un milieu fissure donne. La classe granulometrique d'un coulis, sa stabilite et sa fluidite sont apparus comme les trois facteurs principaux pour la reussite d'une injection. Un facteur de finesse a ete defini au cours de cette etude: base sur la classe granulometrique du ciment et sa stabilite, il peut entrer dans la formulation theorique du debit d'injection avant application sur chantier. La deuxieme et derniere partie de l'etude presente les resultats de deux projets de recherche sur l'injection realises sur chantier. L'injection de dalles de beton fissurees a permis le suivi de l'evolution des pressions avec la distance au point d'injection. L'injection de murs de maconnerie a caractere historique a montre l'importance de la definition de criteres de performance des coulis a utiliser pour traiter un milieu donne et pour un objectif donne. Plusieurs melanges peuvent ainsi etre predefinis et mis a disposition sur le chantier. La complementarite des ciments traditionnels et des ciments microfins devient alors un atout important. Le choix d'utilisation de ces melanges est fonction du terrain rencontre. En conclusion, cette recherche etablit une methodologie pour la selection des coulis a base de ciment et des pressions d'injection en fonction de l'ouverture des fissures ou joints de construction.

  4. 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. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Surface fissures in articular cartilage: new concepts, hypotheses and modeling.

    PubMed

    Kafka, Vratislav

    2002-01-01

    Clarification and mesomechanical modeling of the inception of fissures at the surface of articular cartilage. Articular cartilage is described as a macroscopically heterogeneous medium consisting of zones - layers - with different orientation of collagen fibers. Degradation of mechanical properties of cartilage is a serious, still not fully clarified problem that deserves attention. Theoretical analysis based on a survey of known experimental findings related to the subject. The general author's mesomechanical concept of modeling heterogeneous media is applied to the elucidation and description of the formation of fissures at the surface of articular cartilage. Our model clarifies how the high tensile stresses in the collagen fibers of the superficial tangential zone depend on the rate of loading. The superficial cracks are caused predominantly by a very quick loading. This explains among others the high incidence of post-traumatic osteoarthritis of the lower extremity after accidents and injuries in sports. Superficial fissures in articular cartilage are observed in joints with primary osteoarthritis. The current study specifies the kinds of loading that lead to their inception.

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

    PubMed

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

    2017-06-01

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

  7. 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.

  8. Anal fistula: Intraoperative difficulties and unexpected findings

    PubMed Central

    Abou-Zeid, Ahmed A

    2011-01-01

    Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. 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. PMID:21876613

  9. Nuclear transit studies of patients with intractable chronic constipation reveal a subgroup with rapid proximal colonic transit.

    PubMed

    Yik, Yee Ian; Cain, Timothy M; Tudball, Coral F; Cook, David J; Southwell, Bridget R; Hutson, John M

    2011-07-01

    Nuclear transit studies (NTS) allow us to follow transit through the stomach and the small and large intestines. We identified children with chronic constipation with rapid proximal colonic transit and characterized their clinical features. We reviewed NTS from 1998 to 2009 to identify patients with chronic constipation and rapid proximal colonic transit, defined as greater than 25% of tracer beyond hepatic flexure at 6 hour and/or greater than 25% of tracer beyond end of descending colon at 24 hour. This was correlated with clinical symptoms and outcome from patient records. Five hundred twenty children with chronic constipation underwent investigation by NTS, and 64 (12%) were identified with rapid proximal colonic transit. The clinical history, symptoms, and outcome in 55 of 64 available for analysis frequently showed family history of allergy (10.9%) and symptoms associated with food allergy/intolerance: abdominal pain (80%), anal fissure (27.3%), and other allergic symptoms (43.6%). Eighteen children were treated with dietary exclusion, with resolution of symptoms in 9 (50%). Some children with intractable chronic constipation have rapid proximal colonic transit, have symptoms consistent with possible food allergy/intolerance, and may respond to dietary exclusion. The NTS can identify these patients with rapid proximal transit that may be secondary to food intolerance. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. The fissure: interlobar collateral ventilation and implications for endoscopic therapy in emphysema

    PubMed Central

    Koster, Theodoor David; Slebos, Dirk-Jan

    2016-01-01

    In patients with severe emphysema, bronchoscopic lung volume reduction using one-way valves is a promising therapeutic option to improve lung function and quality of life. The goal of this treatment is to achieve a complete lobar atelectasis. In a significant proportion of patients, this atelectasis cannot be achieved due to interlobar collateral ventilation. This collateral ventilation is generated through incomplete lobar fissures. Therefore, only patients with complete fissures and no collateral ventilation can be selected for endobronchial therapy with one-way valves. Incomplete fissures are very common and exhibit a great variation in anatomy. The reported prevalence is 17%–85% for the right major fissure, 19%–74% for the left major fissure, and 20%–90% for the minor fissure. There are several methods of measuring or predicting the presence of collateral ventilation, with computed tomography (CT)-fissure analysis and the Chartis measurement being the most important. CT-fissure analysis is an indirect method to measure the completeness of fissures as a surrogate for collateral ventilation. The Chartis system is an endobronchial method to directly measure the presence of collateral ventilation. Both methods have unique value, and the combination of both can accurately predict the treatment response to the bronchoscopic placement of endobronchial valves. This review provides an in-depth view of lung fissure and collateral ventilation to help understand its importance in selecting the appropriate patients for new emphysema treatments and thus avoid useless treatment in unsuitable patients. PMID:27110109

  11. The fissure: interlobar collateral ventilation and implications for endoscopic therapy in emphysema.

    PubMed

    Koster, Theodoor David; Slebos, Dirk-Jan

    2016-01-01

    In patients with severe emphysema, bronchoscopic lung volume reduction using one-way valves is a promising therapeutic option to improve lung function and quality of life. The goal of this treatment is to achieve a complete lobar atelectasis. In a significant proportion of patients, this atelectasis cannot be achieved due to interlobar collateral ventilation. This collateral ventilation is generated through incomplete lobar fissures. Therefore, only patients with complete fissures and no collateral ventilation can be selected for endobronchial therapy with one-way valves. Incomplete fissures are very common and exhibit a great variation in anatomy. The reported prevalence is 17%-85% for the right major fissure, 19%-74% for the left major fissure, and 20%-90% for the minor fissure. There are several methods of measuring or predicting the presence of collateral ventilation, with computed tomography (CT)-fissure analysis and the Chartis measurement being the most important. CT-fissure analysis is an indirect method to measure the completeness of fissures as a surrogate for collateral ventilation. The Chartis system is an endobronchial method to directly measure the presence of collateral ventilation. Both methods have unique value, and the combination of both can accurately predict the treatment response to the bronchoscopic placement of endobronchial valves. This review provides an in-depth view of lung fissure and collateral ventilation to help understand its importance in selecting the appropriate patients for new emphysema treatments and thus avoid useless treatment in unsuitable patients.

  12. 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

  13. Nocturnal faecal soiling and anal masturbation.

    PubMed Central

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

    1990-01-01

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

  14. Enamel fusion using a carbon dioxide laser: A technique for sealing pits and fissures

    SciTech Connect

    Walsh, L.J.; Perham, S.J. )

    1991-05-01

    The well-established enhanced resistance of lased enamel to demineralization is the basis for clinical application of the carbon dioxide laser to caries prevention. This in vitro study examined the effect of focused infrared laser radiation on sound enamel and early pit and fissure caries. Low power levels (2-5 W) induced localized melting and resolidification of enamel with little surface destruction. For sound fissures, fusion of enamel from the lateral walls of the fissure eliminated the fissure space, providing a sealant effect; while in carious fissures, carious enamel was vaporized and adjacent sound enamel fused to partially eliminate the defect. The technique for enamel fusion using CO2 lasers has potential application for sealing pits and fissures and producing physicochemical alterations in enamel which may have preventive benefits.

  15. Abnormal vasculature interferes with optic fissure closure in lmo2 mutant zebrafish embryos.

    PubMed

    Weiss, Omri; Kaufman, Rivka; Michaeli, Natali; Inbal, Adi

    2012-09-15

    Ocular coloboma is a potentially blinding congenital eye malformation caused by failure of optic fissure closure during early embryogenesis. The optic fissure is a ventral groove that forms during optic cup morphogenesis, and through which hyaloid artery and vein enter and leave the developing eye, respectively. After hyaloid artery and vein formation, the optic fissure closes around them. The mechanisms underlying optic fissure closure are poorly understood, and whether and how this process is influenced by hyaloid vessel development is unknown. Here we show that a loss-of-function mutation in lmo2, a gene specifically required for hematopoiesis and vascular development, results in failure of optic fissure closure in zebrafish. Analysis of ocular blood vessels in lmo2 mutants reveals that some vessels are severely dilated, including the hyaloid vein. Remarkably, reducing vessel size leads to rescue of optic fissure phenotype. Our results reveal a new mechanism leading to coloboma, whereby malformed blood vessels interfere with eye morphogenesis.

  16. Phimosis with Preputial Fissures as a Predictor of Undiagnosed Type 2 Diabetes in Adults.

    PubMed

    Huang, Yun-Ching; Huang, Yao-Kuang; Chen, Chih-Shou; Shindel, Alan W; Wu, Ching-Fang; Lin, Jian-Hui; Chiu, Kuo-Hsiung; Yang, Tzu-Hsin; Shi, Chung-Sheng

    2016-03-01

    Diabetes is usually asymptomatic in its early stage. Early diagnosis may improve outcomes by enabling initiation of treatment before end organ damage has progressed. The aim of this study was to determine whether the clinical sign of phimosis with preputial fissures is predictive of type 2 diabetes in patients not previously diagnosed with diabetes. Twenty-eight patients with acquired phimosis and preputial fissures were collected prospectively. Twenty-eight controls with acquired phimosis without preputial fissures were selected. Statistically significant differences were found in body mass index, random plasma glucose, glucosuria and glycosylated haemoglobin levels, but not in age, family history of diabetes, hypertension and classical hyperglycaemic symptoms. Diabetes was confirmed in all 28 patients in the preputial fissures group, but only 2 (7.1%) patients in the non-preputial fissures group (p < 0.0001). In conclusion, phimosis with preputial fissures may be a specific sign of undiagnosed diabetes mellitus.

  17. 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 ...

  18. Craniosynostosis, anal anomalies, and porokeratosis (CDAGS syndrome): case report and literature review.

    PubMed

    Chouery, Eliane; Guissart, Claire; Mégarbané, Hala; Aral, Bernard; Nassif, Charbel; Thauvin-Robinet, Christel; Faivre, Laurence; Mégarbané, André

    2013-12-01

    CDAGS syndrome is an autosomal recessive syndrome characterized by craniosynostosis, large open fontanelles, hearing loss, anal anomalies, genitourinary malformations and porokeratosis. To our knowledge, only four families from different geographic regions and ethnic backgrounds have been reported until now and no molecular defect has been identified. Here we report two sisters presenting with craniosynostosis, microcephaly, short downslanting palpebral fissures, sparse hair, eyelashes, and eyebrows and porokeratosis that appeared at the age of one month. The youngest sister had an imperforate anus with rectoperineal fistula. Array-CGH did not reveal any pathological CNV. Molecular analysis of the c16orf57, RECQL4 and MCM5 genes was normal. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  19. Genome-wide association study of primary dentition pit-and-fissure and smooth surface caries

    PubMed Central

    Zeng, Zhen; Feingold, Eleanor; Wang, Xiaojing; Weeks, Daniel E.; Lee, Myoungkeun; Cuenco, Karen T.; Broffitt, Barbara; Weyant, Robert J.; Crout, Richard; McNeil, Daniel W.; Levy, Steven M.; Marazita, Mary L.; Shaffer, John. R.

    2014-01-01

    Dental caries continues to be the most common chronic disease in children today. Despite the substantial involvement of genetics in the process of caries development, the specific genes contributing to dental caries remain largely unknown. We performed separate genome-wide association studies of smooth and pit-and-fissure tooth surface caries experience in the primary dentitions of self-reported white children in two samples from Iowa and rural Appalachia. In total, 1006 children (ages 3-12 years) were included for smooth surface analysis, and 979 children (ages 4-14 years) for pit-and-fissure surface analysis. Associations were tested for more than 1.2 million single nucleotide polymorphisms, either genotyped or imputed. We detected genome-wide significant signals in KPNA4 (p-value = 2.0E-9), and suggestive signals in ITGAL (p-value = 2.1E-7) and PLUNC family genes (p-value = 2.0E-6), thus nominating these novel loci as putative caries susceptibility genes. We also replicated associations observed in previous studies for MPPED2 (p-value = 6.9E-6), AJAP1 (p-value = 1.6E-6) and RPS6KA2 (p-value = 7.3E-6). Replication of these associations in additional samples, as well as experimental studies to determine the biological functions of associated genetic variants, are warranted. Ultimately, efforts such as this may lead to a better understand of caries etiology, and could eventually facilitate the development of new interventions and preventive measures. PMID:24556642

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

    PubMed Central

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

    2014-01-01

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

  1. Surface anatomy of the pulmonary fissures determined by high-resolution computed tomography.

    PubMed

    Heřmanová, Zuzana; Ctvrtlík, Filip; Heřman, Miroslav

    2012-10-01

    The aim of our study was to describe the surface anatomy of the interlobar fissures using volumetric thin-section high-resolution computed tomography (HRCT). Retrospective assessment of HRCT examinations of 250 patients was performed. The localization of the oblique fissures was marked at three sites: posteriorly at its most superior medial limit, laterally in the midaxillary line, and inferiorly at the junction of the middle and lateral thirds of the hemithorax; posteriorly and laterally, this was to the nearest rib whilst inferiorly the position was described in relation to the diaphragm or chest wall. The localization of the horizontal fissure was marked anteriorly in relation to the nearest rib (or costal cartilage) and posteriorly where it intersected with the oblique fissure (superior, middle, or inferior third). Shapes of the fissures and differences between inspiration and expiration were also documented. Descriptive statistics were used to report the most frequent positions. The most frequent localization of the oblique fissure on the left side was posteriorly at the fourth rib (45%), laterally at the sixth rib (52%), and inferiorly in the anterior third of the hemidiaphragm (60%). The right oblique fissure was located posteriorly at the fifth rib (50%), laterally at the sixth rib (50%), and inferiorly in the anterior third of the hemidiaphragm (71%). The horizontal fissure most commonly originated in the middle third of the oblique fissure (61%) and met the anterior thoracic wall at the level of the fourth rib (51%). The most frequent shape of the left oblique fissure was linear (78%), whereas S-shaped and linear configurations (28% each) were most frequent on the right. No difference was found in the surface markings of the fissures between inspiration and expiration in 90% of cases. The considerable individual variation in the position and shape of the interlobar fissures helps to explain the variable descriptions of their surface anatomy in the

  2. Joints, fissures, and voids in rhyolite welded ash-flow tuff at Teton damsite, Idaho

    USGS Publications Warehouse

    Prostka, Harold J.

    1977-01-01

    Several kinds of joints, fissures, and voids are present in densely welded rhyolite ash-flow tuff at Teton damsite. Older fissures and voids probably were formed in the ash-flow sheet during secondary flowage, which probably was caused by differential compaction or settling over irregular topography. The younger, more abundant fissures are mostly steep cooling joints that probably have been opened farther by horizontal tectonic extension and gravitational creep, perhaps aided by lateral stress relief.

  3. Research of features related to land subsidence and ground fissure disasters in the Beijing Plain

    NASA Astrophysics Data System (ADS)

    Yang, Y.; Luo, Y.; Liu, M.; Wang, R.; Wang, H.

    2015-11-01

    This study overviews the development history, current situation, impact, and hazards of land subsidence and ground fissure disasters in the Beijing Plain (BP) and focuses on the disaster distribution and features of disaster-causing mechanisms. Currently, the BP is still in a rapid developmental stage of land subsidence. The development and distribution of land subsidence are affected by various factors including the thickness of Quaternary compressible clay, groundwater overexploitation, and the rapid development of urban construction. The causes of ground fissures in the BP are complex and diverse, with evidence of structure fissures, non-structure fissures, and mixed genesis fissures. Investigations of the Gaoliying ground fissure have shown that this fissure has evidence of fracture activity, with vertical deformation that is more significant than horizontal deformation. Furthermore, this ground fissure has characteristics of inter-annual periodicity and annual jumping. The land subsidence and ground fissures are all under structural control and impact each other, and more severe hazards may be induced under the superimposition of these two types of disasters. Effective measures and suggestions for disaster prevention and control are recommended on the basis of this study.

  4. On homogenization of a variational inequality for an elastic body with periodically distributed fissures

    SciTech Connect

    Pastukhova, S E

    2000-02-28

    We study the problem of small deformations of an elastic body with periodically distributed fissures, where one-sided constraints are imposed on the sides of the fissures; this problem is equivalent to a variational inequality. We prove that if the linear size of the period of the distribution of the fissures tends to zero, then the solutions of this problem converge in the L{sup 2}-norm to the solution of the homogenized problem, which is a non-linear boundary-value problem of elasticity theory for a domain without fissures.

  5. Fluoride release and uptake abilities of different fissure sealants

    PubMed Central

    Andenna, Gianluigi; Ceci, Matteo; Beltrami, Riccardo; Colombo, Marco; Cucca, Lucia

    2016-01-01

    Background The long-term capability of resin sealants and glass ionomer cements to release fluoride is associated to a reduction in pit and fissure caries. The regular use of fluoride varnishes/toothpastes can result in the absorption of fluoride into the sealant. The objective of the present study was to assess the fluoride release/uptake capacities of different fissure sealants. Material and Methods Three different fissure sealants (Fuji Triage/GC, Fissurit FX/Voco and Grandio Seal/Voco) were examined. Ten discs of each material were prepared. Each disc was incubated with distilled water and then the solution analyzed for diluted for fluoride concentration, using a combination of fluoride electrode (OrionGP 1 S/N 13824, Orion Research Inc, Boston, MA, USA) connected to an expandable ion analyzer (Orion 720A, Orion Research Inc, Boston, MA, USA). Standard curves between 1 and 100 ppm F- were used to calibrate the electrode. Cumulative fluoride release was measured on days 1, 2, 3, 5, 7, 21, 35 and 49, then two different fluoride varnishes/pastes (Profluorid Varnish/Voco, MI Paste Plus/GC), were applied to the sealants tested, and fluoride release (after reuptake) was measured on days 56, 70 and 84. Results Kruskal Wallis test confirmed significant differences in fluoride release between Fuji Triage/GC and Fissurit FX/Voco and Grandio Seal/Voco from day 1 (P < 0.001). The application of fluoride varnish Profluorid Varnish enhanced the fluoride release for all sealants (P < 0.05). MI Paste Plus enhanced the fluoride release for all sealants except for Fuji Triage/GC (P > 0.05). Conclusions The GIC-based sealant (Fuji Triage/GC) released significantly more fluoride than the resin sealants tested. The exposure to the fluoridated varnish (Profluorid Varnish) significantly recharged the sealants tested more than the CPP-ACPF toothpaste (MI Paste Plus). Key words:Fissure sealants, fluoride release, fluoride uptake, glass ionomer cements. PMID:27398179

  6. Bonding Agents in Pit and Fissure Sealants: A Review

    PubMed Central

    Das, Usha Mohan; G, Suma

    2009-01-01

    Dental adhesive systems used for bonding dental resins to enamel and dentin have evolved through several "generations," with changes in chemistry, mechanism, number of bottles, application technique, and clinical effectiveness. The trend in the latest generation of dental bonding systems is to reduce the number of components and clinical placement steps. The introduction of i bond, a single-bottle dental adhesive system, is the latest of the new generation materials, and combines etchant, adhesive, and desensitizer in one component. This paper describes different dentin bonding agents, its evolution, mechanism of action and different commercially available dentin bonding agents and their role in the retention of pit and fissure sealant. PMID:25206115

  7. Eruption Conditions During Fissure Eruptions in Tharsis, Mars.

    NASA Astrophysics Data System (ADS)

    Wilson, L.; Mouginis-Mark, P. J.; Tyson, S.; Mackown, J.; Garbeil, H.

    2008-12-01

    We focus on six separate, but physically close, vent systems in eastern Tharsis, Mars, just to the east of the volcano Jovis Tholus. The vents are typically linear fissures a few to 20 km in length that have built small shields rising to 50-85 m above the level of the surrounding topography. Typical lengths of individual lava flows from these fissures are 15-20 km, with a maximum of 30 km. Mapping of the vent complexes reveals smooth material, interpreted to be spatter from fire fountaining, located on the rims of some of the fissures. In some places this spatter fed individual short (less than 5 km) lava flows; elsewhere spatter from segments of the fissure coalesced to form longer flows. Temporal evolution of the flow fields is indicated: the oldest parts of the basement at each center are built from a series of compound flows that cannot be subdivided into individual flows. In places activity was locally focussed and formed lava ponds and channelized flows from central vents. MOLA topographic data and photoclinometry topographic profiles made from THEMIS VIS images show that the flows are typically less than 5 m thick, 8-15 times thinner than flows elsewhere on Mars. We used standard models of magma rise through dikes, lava flow emplacement, and fire-fountain behavior to find lava viscosities and yield strengths (100 Pa s and 100 Pa, respectively), eruption rates (5,000 m3/s), flow speeds (1-2 m/s), durations of emplacement of individual flow units (5 hours), and an equivalent magma water content (0.1-0.2 mass percent). These eruption conditions are consistent with a wide range of possible depths of the magma reservoirs feeding the eruptions. Small vents like those studied here have been identified elsewhere in Tharsis (particularly just to the east of Olympus Mons), and the eruption conditions described above may characterize a previously poorly recognized style of volcanism on Mars only identifiable in images with spatial resolutions better than 10 m/pixel.

  8. Sylvian fissure epidermoid cyst presenting with intention tremor

    PubMed Central

    Shah, Abhidha; Makkiyah, Feda; Goel, Atul

    2016-01-01

    Epidermoid tumors are benign tumors which contain keratin, cellular debris, and cholesterol, and are lined with stratified squamous epithelium. They grow in discreet silence sustained over a multitude of years. The tumors most commonly present with headache and seizures. We report the case of a 24-year-old male with a large sylvian fissure epidermoid tumor who presented with intention tremor. The patient was operated, and a near-total excision of the tumor was performed with a resolution of the tremor. PMID:27057232

  9. On the etiology of anal squamous carcinoma.

    PubMed

    Frisch, Morten

    2002-08-01

    The thesis is based on 13 publications in English and a review of the literature. The underlying work was done with the overall aim to describe incidence patterns for anal squamous carcinoma (anal SC) and to contribute new insight into the causes of this neoplasm. The work, supported by the Danish Cancer Society, was carried out in the period 1991-2000 while I was employed at 1) the Danish Cancer Registry, 2) Statens Serum Institute, Department of Epidemiology Research, and 3) the National Cancer Institute, Viral Epidemiology Branch, Maryland. Study designs employed include a ) population-based incidence studies in Denmark and the United States, b) register-based case-control studies and cohort studies for the scrutiny of multiple cancer patterns among patients with anal SC and for the study of anal SC risk among individuals with certain non-malignant diseases of the anal region as well as among persons with the acquired immuno-deficiency syndrome (AIDS), c) a nationwide interview-based case-control study of risk factors for anal SC and in Denmark and Sweden, and d) a combined molecular biological and histological analysis examining the association of human papillomavirus (HPV) status with histopathological and anatomical characteristics in anal SC tissues. The epidemiology of anal SC has changed remarkably during the second half of the 20th century. In Denmark, age-adjusted incidence rates per 100,000 person-years increased during the period 1943-1997 from around 0.2 among both men an women to 0.5 among men and 1.0 among women. Where systematically studied, incidence rates of anal SC have also been found to increase in a few other countries (Sweden and the United States). Register-based multiple cancer studies have shown an excess of previous and subsequent genital cancers of squamous histology among women with anal SC. This is likely to reflect common susceptibility toward infection with cancer-associated HPV types shared by all anogenital organs covered by

  10. Chemoradiotherapy for anal squamous cell carcinoma.

    PubMed

    Houlihan, Orla A; O'Neill, Brian D P

    2016-08-01

    Anal cancer is a relatively rare cancer, making up approximately 0.4% of all new diagnoses of cancer.(1) The incidence of anal cancer, however, has increased in recent years.(2) The aim of this paper is to review current treatment of anal squamous cell carcinoma (SCC), the most common type of anal cancer. This review article focuses on recent and ongoing trials studying the outcomes of various chemoradiotherapy (CRT) regimens in the treatment of anal SCC. PubMed was initially searched for relevant trials. This search was then supplemented by hand searches of reference lists and abstracts of relevant conferences. CRT with mitomycin C (MMC) and 5-fluorouracil (5-FU) has been proven to have effective results in the treatment of anal SCC. Salvage surgery has a role in some patients in the treatment of persistent or recurrent disease beyond 26 weeks. The addition of induction or maintenance chemotherapy to CRT has not been shown to have any benefit. Primary CRT with MMC and 5-FU is the current standard treatment for anal SCC. There is currently no role for induction or maintenance chemotherapy. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  11. 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.

  12. New Techniques for Treating an Anal Fistula

    PubMed Central

    2012-01-01

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

  13. 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.

  14. Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth.

    PubMed

    Evers, Emily C; Blomquist, Joan L; McDermott, Kelly C; Handa, Victoria L

    2012-11-01

    The purpose of this study was to investigate the long-term impact of anal sphincter laceration on anal incontinence. Five to 10 years after first delivery, anal incontinence and other bowel symptoms were measured with the Epidemiology of Prolapse and Incontinence Questionnaire and the short form of the Colorectal-Anal Impact Questionnaire. Obstetric exposures were assessed with review of hospital records. Symptoms and quality-of-life impact were compared among 90 women with at least 1 anal sphincter laceration, 320 women who delivered vaginally without sphincter laceration, and 527 women who delivered by cesarean delivery. Women who sustained an anal sphincter laceration were most likely to report anal incontinence (odds ratio, 2.32; 95% confidence interval, 1.27-4.26) and reported the greatest negative impact on quality of life. Anal incontinence and quality-of-life scores were similar between women who delivered by cesarean section and those who delivered vaginally without sphincter laceration. Anal sphincter laceration is associated with anal incontinence 5-10 years after delivery. Copyright © 2012 Mosby, Inc. All rights reserved.

  15. Fetal growth of the anal sinus and sphincters, especially in relation to anal anomalies.

    PubMed

    Arakawa, Takashi; Hwang, Si Eun; Kim, Ji Hyun; Wilting, Joerg; Rodríguez-Vázquez, José Francisco; Murakami, Gen; Hwang, Hong Pil; Cho, Baik Hwan

    2016-03-01

    The anal sinuses, small furrows above the pectinate line, sometimes form perianal abscesses in adults. We examined the pattern of fetal growth of the anal sinus and sphincters using 22 mid-term (8-18 weeks) and 6 late-stage (30-38 weeks) fetuses. In mid-term fetuses, the external and internal sphincters gradually increased in thickness, depending on specimen size (from 0.2 to 1.5 mm), whereas the anteroposterior diameter of the anal canal at the epithelial junction was relatively stable (0.5-1.0 mm) irrespective of specimen size. Anal canal diameter increased less than twofold between mid-term and late-stage fetuses, from 0.5-1.0 to almost 2 mm, whereas sphincter thickness increased over tenfold, from 0.2-1.5 to almost 3.5 mm. The anal sinus often showed balloon-like enlargement when the sphincter muscle bundles were tightly packed in mid-term, but not in late-stage fetuses. Large concentric mechanical stress from the sphincters in late-stage fetuses apparently prevented the anal sinus from expanding in a balloon-like manner. Conversely, to avoid anal stenosis, the growing sinuses maintained a luminal space of the anal canal in response to stress from rapidly growing sphincters. The inferiorly extending sinus usually provided temporal double canals separated by a thick column. In the presence of double lumens, anal canal duplication is likely to develop without any abnormalities of the anal epithelium and sphincters.

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

    PubMed

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

    2017-07-01

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

  17. 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.

  18. 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.

  19. Fissure sealants: Knowledge and practice of Yemeni dental practitioners

    PubMed Central

    Al-Maweri, Sadeq Ali; Al-Jamaei, Aisha Ahmed; Halboub, Esam Saleh; Al-Soneidar, Walid Ahmed; Tarakji, Bassel; Alsalhani, Anas

    2016-01-01

    Objectives This study was conducted to evaluate Yemeni dental practitioners' knowledge and practices concerning fissure sealants. Materials and Methods: A modified questionnaire consisted of 25-items was distributed to 500 dentists working in Sana'a City. Descriptive statistics and Chi-square/Fisher's exact tests were used for statistical analyses. Results: The response rate was 74%. Most of the respondents were male (61.3%), general practitioners (84.2%), and had <5 years of clinical experience (48.3%). The respondents showed a reasonable level of knowledge about sealants, with the majority (88%) believed that there is strong scientific evidence about fissure sealants effectiveness and around 90% showed a good understanding of sealant placement instructions. On the other hand, respondents showed insufficient knowledge about sealants clinical practice. Conclusion: Although a high proportion of dental practitioners showed adequate knowledge about dental sealant, following guidelines and standardized procedures in clinical practice is lacking. These emphasize the need for regular continuing education courses for dental professional. PMID:27095903

  20. Preserving rice quality: fine mapping and introgressing a fissure resistance locus

    USDA-ARS?s Scientific Manuscript database

    Rice (Oryza sativa L.) kernel fissuring is a major concern of both rice producers and millers. Fissures are small cracks in the rice kernels that increase the percentage of breakage among the kernels when they are transported and milled, which decreases the value of processed rice. This study employ...

  1. Response to early generation selection for resistance to rice kernel fissuring

    USDA-ARS?s Scientific Manuscript database

    The value of milled rice (Oryza sativa L.) depends on the percent whole versus broken kernels after milling. Kernel fissures caused by pre- or post-harvest stresses are the leading cause of breakage upon milling. ‘Cypress’ is known to be more fissure resistant (FR) than most cultivars, but breeding ...

  2. Early screening of recombinant inbred lines for fissure resistance in non-semidwarf rice

    USDA-ARS?s Scientific Manuscript database

    Rice (Oryza sativa L.) kernel fissuring poses a major problem for both rice farmers and millers. It results in the decreased value of milled rice because of the increase in the percentage of broken kernels associated with fissuring. This study employs the use of fine mapping to increase the genetic ...

  3. Pulmonary fissure development is a prognostic factor for patients with resected stage I lung adenocarcinoma.

    PubMed

    Lee, Seokkee; Lee, Jin Gu; Lee, Chang Young; Kim, Dae Joon; Chung, Kyung Young

    2016-12-01

    Pulmonary fissure differs among patients, but the relationship between pulmonary fissure development and survival in patients with resected lung adenocarcinoma has not been evaluated. In this study, we analyzed the effect of fissure development on prognosis in patients with stage I lung adenocarcinoma. From January 2009 to December 2012, data, including pulmonary fissure development, were collected prospectively for all lung cancer, and this was a retrospective study of prospectively collected data. In total, 297 patients who had undergone a lobectomy and had pathologic stage I adenocarcinoma were analyzed. Patients were categorized into two groups based on fissure sum average (FSA) fissure development scores. Group A patients ranged from complete to 30% incomplete (0 ≤ FSA ≤ 1) while in Group B patients development was more than 30% incomplete (1 < FSA ≤ 3). In univariate analysis, Group B had poorer overall 5 year survival than did Group A (83.1% vs. 96.5%, P = 0.015). Multivariate analysis revealed that the level of fissure development was a significant prognostic factor for overall survival (HR = 3.905, CI = 1.168-13.057, P = 0.027). The overall survival of patients with resected stage I adenocarcinoma was adversely affected by incomplete fissure development. J. Surg. Oncol. 2016;114:848-852. © 2016 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  4. Fissure eruptions at Mount Vesuvius (Italy): Insights on the shallow propagation of dikes at volcanoes

    NASA Astrophysics Data System (ADS)

    Acocella, Valerio; Porreca, Massimiliano; Neri, Marco; Mattei, Massimo; Funiciello, Renato

    2006-08-01

    Fissure eruptions may provide important information on the shallow propagation of dikes at volcanoes. Somma-Vesuvius (Italy) consists of the active Vesuvius cone, bordered to the north by the remnants of the older Somma edifice. Historical chronicles are considered to define the development of the 37 fissure eruptions between A.D. 1631 and 1944. The 1631 fissure, which reopened the magmatic conduit, migrated upward and was the only one triggered by the subvertical propagation of a dike. The other 25 fissure eruptions migrated downward, when the conduit was open, through the lateral propagation of radial dikes. We suggest two scenarios for the development of the fissures. When the summit conduit is closed, the fissures are fed by vertically propagating dikes. When the summit conduit is open, the fissures are fed by laterally propagating dikes along the volcano slopes. Consistent behaviors are found at other composite volcanoes, suggesting a general application to our model, independent of the tectonic setting and composition of magma. At Vesuvius, the historical data set and our scenarios are used to predict the consequences of the emplacement of fissures after the opening of the conduit. The results suggest that, even though the probability of opening of vents within the inhabited south and west slopes is negligible, the possibility that these are reached by a lava flow remains significant.

  5. Neoplasms of Anal Canal and Perianal Skin

    PubMed Central

    Leonard, Daniel; Beddy, David; Dozois, Eric J.

    2011-01-01

    Tumors of the anus and perianal skin are rare. Their presentation can vary and often mimics common benign anal pathology, thereby delaying diagnosis and appropriate and timely treatment. The anatomy of this region is complex because it represents the progressive transition from the digestive system to the skin with many different co-existing types of cells and tissues. Squamous cell carcinoma of the anal canal is the most frequent tumor found in the anal and perianal region. Less-frequent lesions include Bowen's and Paget's disease, basal cell carcinoma, melanoma, and adenocarcinoma. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for neoplasms of the anal canal and perianal skin. PMID:22379406

  6. Evaluation of Different Fissure Sealant Materials and Flowable Composites Used as Pit-and-fissure Sealants: A 24-Month Clinical Trial.

    PubMed

    Kucukyilmaz, Ebru; Savas, Selcuk

    2015-01-01

    The effectiveness of resin-based pit-and-fissure sealants mainly depends on their retention and integrity over time. The purpose of this study was to evaluate retention rates of two different pit-and-fissure sealants compared with a flowable composite and a self-adhesive flowable composite over a 24 month period. A split-mouth study design was used for all four permanent first molars of each patient. They were subjected to different kinds of sealants--either flowable composites or with fissure sealants. The flowable composites used were: flowable composite with an adhesive system (Tetric EvoFlow); and a self-adhesive flowable composite (Vertise Flow). The fissure sealants used were: a highly filled pit-and-fissure sealant (Fissurit FX); and a highly filled nano-hybrid pit-and-fissure sealant (Grandio Seal). Evaluation of the sealants was carried out at three-, six-, 12-, 18-, and 24-month follow-up visits. The complete retention rates were 95.7 percent for Tetric EvoFlow, 80.6 percent for Fissurit FX, 73.1 percent for Grandio Seal, and 62.9 percent for Vertise Flow. The retention rate of Tetric EvoFlow was significantly higher among all materials tested (P<0.05). The flowable composite used with an adhesive system was found to be superior to other sealing materials.

  7. Comparison of different methods of cleaning and preparing occlusal fissure surface before placement of pit and fissure sealants: An in vivo study.

    PubMed

    Hegde, Rahul J; Coutinho, Rochelle C

    2016-01-01

    To evaluate an individual method of cleaning and preparing occlusal fissure surface before placement of pit and fissure sealant and to determine a method for better retention of the sealant. The present study consisted of 100 young permanent molar teeth divided into four equal groups: Group 1-Brushing only, Group 2-Application of pumice slurry, Group 3-Surface conditioning, and Group 4-Control (without any preparation). Subsequent to fissure preparation, the fissures were etched using 37% phosphoric acid except for Group 3, which was etched using 10% maleic acid for 30 s. The samples were then rinsed for 10 s using air water spray of the three-way syringe and dried using oil-free compressed air with a hand pump air pressure syringe. After ensuring a frosted appearance of the enamel at the fissure entrance, pit and fissure sealants were applied on the surface according to manufacturer's instructions. All the cases were clinically evaluated for retention after 3 months, 6 months, and 12 months of application and the retention rate was assessed based on the criteria proposed by Simonsen. The pumice slurry group and surface conditioning group showed results with 100%, 96%, and 92% complete retention seen at 3 months, 6 months, and 12 months, respectively. The pumice slurry group and surface conditioning group showed a significantly higher retention when compared to the brushing group, whereas the control group (without any preparation) showed the least retention when compared to all the other groups.

  8. Surface fissures in articular cartilage: effect of pathological changes in synovial fluid.

    PubMed

    Kafka, Vratislav

    2002-01-01

    A unified mathematical model of two different modes of inception of fissures at the surface of articular cartilage in healthy and pathological joints. The superficial tangential zone of articular cartilage is modeled as a three-phase medium consisting of collagen fibers, matrix, and of infiltrated thin constituent of synovial fluid. The author's general mesomechanical concept is applied to the analysis of deterioration of articular cartilage. Theoretical analysis based on the results of the author's preceding paper. The presented analysis shows that superficial fissures in articular cartilage can also be caused by pathological thinning of synovial fluid. Whereas in healthy joints the probable cause of creation of fissures at the surface of cartilage was shown to be fast impact loading, in joints with inflammatory synovial fluid the fissures can be caused by plain walking. Appearance of surface fissures in articular cartilage is a serious, still not fully clarified problem that deserves attention.

  9. Groundwater-Mining-Induced Subsidence and Earth Fissures in Cedar Valley, Southwestern Utah

    NASA Astrophysics Data System (ADS)

    Knudsen, T. R.; Inkenbrandt, P.; Lund, W. R.; Lowe, M.; Bowman, S. D.

    2014-12-01

    Groundwater pumping in excess of recharge (groundwater mining) has lowered the potentiometric surface in Cedar Valley, southwestern Utah, by as much as 114 feet since 1939. Lowering the potentiometric surface (head decline) has caused permanent compaction of fine-grained sediments of the Cedar Valley aquifer. Recently acquired interferometric synthetic aperture radar (InSAR) imagery shows that land subsidence is occurring over an ~100 square-mile area, including two pronounced subsidence bowls in the northeastern (Enoch graben) and southwestern (Quichapa Lake area) parts of the valley. A lack of accurate historical benchmark elevation data over much of the valley prevents detailed long-term quantification of subsidence. In response to the land subsidence, earth fissures have formed along the margins of the Enoch graben and north and west of Quichapa Lake. Our initial inventory of Cedar Valley fissures, which relied on aerial-photography analysis, identified 3.9 miles of fissures in 2009. With newly acquired light detection and ranging (LiDAR) coverage in 2011, we more than doubled the total length of mapped fissures to 8.3 miles. Fissures on the west side of the Enoch graben exhibit ongoing vertical surface displacement with rates as high as 1.7 inches/year. The largest Enoch-graben-west fissure has displaced street surfaces, curb and gutter, and sidewalks, and has reversed the flow direction of a sewer line in a partially developed subdivision. Several Cedar Valley fissures are closely associated with, and in some places coincident with, mapped Quaternary faults. While the majority of Cedar Valley fissures are mapped in agricultural areas, continued groundwater mining and resultant subsidence will likely cause existing fissures to lengthen and new fissures to form that may eventually impact other developed areas of the valley.

  10. Annulus fissures are mechanically and chemically conducive to the ingrowth of nerves and blood vessels.

    PubMed

    Stefanakis, Manos; Al-Abbasi, Maan; Harding, Ian; Pollintine, Phillip; Dolan, Patricia; Tarlton, John; Adams, Michael A

    2012-10-15

    Mechanical and biochemical analyses of cadaveric and surgically removed discs. To test the hypothesis that fissures in the annulus of degenerated human discs are mechanically and chemically conducive to the ingrowth of nerves and blood vessels. Discogenic back pain is closely associated with fissures in the annulus fibrosus, and with the ingrowth of nerves and blood vessels. Three complementary studies were performed. First, 15 cadaveric discs that contained a major annulus fissure were subjected to 1 kN compression, while a miniature pressure transducer was pulled through the disc to obtain distributions of matrix compressive stress perpendicular to the fissure axis. Second, Safranin O staining was used to evaluate focal loss of proteoglycans from within annulus fissures in 25 surgically removed disc samples. Third, in 21 cadaveric discs, proteoglycans (sulfated glycosaminoglycans [sGAGs]) and water concentration were measured biochemically in disrupted regions of annulus containing 1 or more fissures, and in adjacent intact regions. Reductions in compressive stress within annulus fissures averaged 36% to 46%, and could have been greater at the fissure axis. Stress reductions were greater in degenerated discs, and were inversely related to nucleus pressure (R(2) = 47%; P = 0.005). Safranin O stain intensity indicated that proteoglycan concentration was typically reduced by 40% at a distance of 600 μm from the fissure axis, and the width of the proteoglycan-depleted zone increased with age (P < 0.006; R(2) = 0.29) and with general proteoglycan loss (P < 0.001; R(2) = 0.32). Disrupted regions of annulus contained 36% to 54% less proteoglycans than adjacent intact regions from the same discs, although water content was reduced only slightly. Annulus fissures provide a low-pressure microenvironment that allows focal proteoglycan loss, leaving a matrix that is conducive to nerve and blood vessel ingrowth.

  11. Video monitoring analysis of the dynamics at fissure eruptions

    NASA Astrophysics Data System (ADS)

    Witt, Tanja; Walter, Thomas R.

    2016-04-01

    At basaltic eruption often lava fountains occur. The fountains mainly develop at erupting fissures, underlain by a magma-filled dike transporting the magma horizontally and vertically. Understanding of the dynamics of the deep dike and fracture mechanisms are mainly based on geophysical data as well as observations from seismic or geodetic networks. At the surface, however, new methods are needed to allow detailed interpretation on the eruption velocities, interactions between vents and complexities in the magma paths. With video cameras we collected imaging data from different erupting fissures. We find that lava fountaining is often correlated at distinct vents. From the frames of the videos we calculated the height and velocities of fountains as a function of time. Lava fountains often show a pulsating regime, that may change over time. Comparing the fountain height as a function of time of different vents by an time-dependent cross-correlation, we find a time lag between the pulses at adjacent vents. From this we derive an apparent velocity of temporal separation between vents, associated with the fountaining activity based on the calculated time lag and the vent distances. Although the correlation system can change episodically and sporadically, both the frequency of the fountains and eruption and the rest time between single fountains remain remarkably similar for adjacent lava fountains imply a controlling process in the magma feeder system itself. We present and compare our method for the Kamoamoa eruption 2011 (Hawaii) and the Holuhraun eruption 2014/2015 (Iceland). Both sites show a significant time shift between the single pulses of adjacent vents. We compare our velocities determined by this time shift to the assumed magma flow velocity in the dike as determined by independent models. Therefore we conjecture that the time shift of venting activity may allow to estimate the dynamics of magma and fluid migration at depth, as well as to identify the

  12. Anal Neoplasia in Inflammatory Bowel Disease: Classification Proposal, Epidemiology, Carcinogenesis, and Risk Management Perspectives.

    PubMed

    Wisniewski, Andrew; Fléjou, Jean-Francois; Siproudhis, Laurent; Abramowitz, Laurent; Svrcek, Magali; Beaugerie, Laurent

    2017-08-01

    Patients with inflammatory bowel disease [IBD] may develop, similarly to individuals from general population, rare cases of human papilloma virus [HPV]-related anal canal squamous cell carcinoma [SCC] and intra-epithelial precursor lesions, as well as very rare cases of anal canal adenocarcinoma. Patients with chronic perianal Crohn's disease [CD] are at substantial risk of developing SCC or adenocarcinoma from the fistula-lining epithelium, as well as SCC or adenocarcinoma arising from chronic anorectal ulcerations or strictures. Based on this lesion stratification, we provide in this review tailored incidence estimates and we propose an IBD-specific classification of all types of anal neoplasia that may occur in patients with IBD. After reviewing putative carcinogenesis of all types of neoplasia, we conclude that HPV vaccination could reduce the incidence of HPV-related lesions, although an anal screening programme related to these lesions is not mandatory on the sole basis of IBD. By contrast, we point out that all patients with chronic perianal CD should be explored in depth, including biopsies under anaesthesia and fistula curettage when necessary, in case of any change in anal symptoms ─in particular new, increasing, unexplained pain. Finally, we conclude that there is an urgent need for elaborating and evaluating surveillance algorithms in patients with chronic perianal CD, in order to avoid cancers with late diagnosis and poor prognosis. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  13. Insular and Sylvian Fissure Dermoid Cyst with Giant Cell Reactivity: Case Report and Review of Literature.

    PubMed

    Garces, Juanita; Mathkour, Mansour; Beard, Bryce; Sulaiman, Olawale A R; Ware, Marcus L

    2016-09-01

    Dermoid cysts are rare intracranial tumors that are most commonly found infratentorially and along the midline. Characterized by slow growth and often found incidentally, these lesions can nonetheless have severe complications, notably rupture leading to chemical meningitis. They infrequently present as a supratentorial and lateralized mass. As such, sylvian fissure dermoid cysts are exquisitely rare. We present a rare case of a dermoid cyst with giant cell reactivity suggestive of focal rupture and chronic inflammation. A 61-year-old female presented with new-onset seizures. Magnetic resonance imaging revealed a right insular mass measuring 4.3 × 4.5 cm with compression of the ipsilateral frontal and temporal lobes. The mass was nonenhancing; however, it was bright on diffusion-weighted imaging, suggesting a dermoid cyst. She underwent craniotomy for tumor resection. Histologic analysis revealed keratinizing squamous epithelium, sebaceous glands, and hair follicles associated with giant cell reaction involving the capsule of the cyst consisted with dermoid cyst. At 2.5 years post operation, she is seizure free and without evidence of recurrence. The dermoid cyst in our patient was not grossly ruptured, but histopathologic analysis revealed giant cell reactivity, which may indicate focal rupture or chronic inflammation. The relationship between rupture of dermoid cysts and inflammation is not well elucidated. It is not known whether symptoms occur immediately after rupture or as an acute manifestation of a chronic process following rupture. As these lesions are quite rare and rupture is even rarer, more diligence on our part regarding details of histopathology for dermoid cysts is necessary. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Discrete element modeling on the crack evolution behavior of brittle sandstone containing three fissures under uniaxial compression

    NASA Astrophysics Data System (ADS)

    Yang, Sheng-Qi; Huang, Yan-Hua; Ranjith, P. G.; Jiao, Yu-Yong; Ji, Jian

    2015-12-01

    Based on experimental results of brittle, intact sandstone under uniaxial compression, the micro-parameters were firstly confirmed by adopting particle flow code (PFC^{2D}). Then, the validation of the simulated models were cross checked with the experimental results of brittle sandstone containing three parallel fissures under uniaxial compression. The simulated results agreed very well with the experimental results, including the peak strength, peak axial strain, and ultimate failure mode. Using the same micro-parameters, the numerical models containing a new geometry of three fissures are constructed to investigate the fissure angle on the fracture mechanical behavior of brittle sandstone under uniaxial compression. The strength and deformation parameters of brittle sandstone containing new three fissures are dependent to the fissure angle. With the increase of the fissure angle, the elastic modulus, the crack damage threshold, and the peak strength of brittle sandstone containing three fissures firstly increase and secondly decrease. But the peak axial strain is nonlinearly related to the fissure angle. In the entire process of deformation, the crack initiation and propagation behavior of brittle sandstone containing three fissures under uniaxial compression are investigated with respect to the fissure angle. Six different crack coalescence modes are identified for brittle sandstone containing three fissures under uniaxial compression. The influence of the fissure angle on the length of crack propagation and crack coalescence stress is evaluated. These investigated conclusions are very important for ensuring the stability and safety of rock engineering with intermittent structures.

  15. Mesenchymal stem cells can improve anal pressures after anal sphincter injury☆

    PubMed Central

    Salcedo, Levilester; Mayorga, Maritza; Damaser, Margot; Balog, Brian; Butler, Robert; Penn, Marc; Zutshi, Massarat

    2016-01-01

    Objective Fecal incontinence reduces the quality of life of many women but has no long-term cure. Research on mesenchymal stem cell (MSC)-based therapies has shown promising results. The primary aim of this study was to evaluate functional recovery after treatment with MSCs in two animal models of anal sphincter injury. Methods Seventy virgin female rats received a sphincterotomy (SP) to model episiotomy, a pudendal nerve crush (PNC) to model the nerve injuries of childbirth, a sham SP, or a sham PNC. Anal sphincter pressures and electromyography (EMG) were recorded after injury but before treatment and 10 days after injury. Twenty-four hours after injury, each animal received either 0.2 ml saline or 2 million MSCs labelled with green fluorescing protein (GFP) suspended in 0.2 ml saline, either intravenously (IV) into the tail vein or intramuscularly (IM) into the anal sphincter. Results MSCs delivered IV after SP resulted in a significant increase in resting anal sphincter pressure and peak pressure, as well as anal sphincter EMG amplitude and frequency 10 days after injury. MSCs delivered IM after SP resulted in a significant increase in resting anal sphincter pressure and anal sphincter EMG frequency but not amplitude. There was no improvement in anal sphincter pressure or EMG with in animals receiving MSCs after PNC. GFP-labelled cells were not found near the external anal sphincter in MSC-treated animals after SP. Conclusion MSC treatment resulted in significant improvement in anal pressures after SP but not after PNC, suggesting that MSCs could be utilized to facilitate recovery after anal sphincter injury. PMID:23147650

  16. Recent smoking is a risk factor for anal abscess and fistula.

    PubMed

    Devaraj, Bikash; Khabassi, Soheil; Cosman, Bard C

    2011-06-01

    factor for anal abscess/fistula diminishes to baseline after 5 to 10 years of smoking cessation. Anal abscess/fistula can be added to the list of chronic, inflammatory cutaneous conditions associated with smoking.

  17. Evidence not practised: the underutilisation of preventive fissure sealants.

    PubMed

    Bonetti, D L

    2014-04-01

    International and UK professional organisations, Cochrane systematic reviews, and international and UK guidance documents all support the application of preventive fissure sealants (PFSs) as an effective treatment for reducing caries. However, PFSs are well known to be underutilised in primary care. This paper collates data from PFS-relevant studies in Scotland, which has a large population of children at caries risk, to identify the beliefs and factors dentists perceive as influencing their decision not to provide this treatment. This information provides a platform to suggest how to increase the application of PFSs in this region (a standardised audit incorporating evidence-based behaviour change techniques, supplemental guidance on how to implement gold-standard recommendations in practice, training). This may also be relevant outside of Scotland, as well as to the implementation of other evidence-based behaviours in practice.

  18. Superior orbital fissure syndrome in herpes zoster ophthalmicus.

    PubMed

    Kirwan, R P; Abdalla, M; Hogan, A; Tubridy, N; Barry, P; Power, W

    2009-09-01

    To report a case of superior orbital fissure syndrome (SOFS) in a patient with herpes zoster ophthalmicus (HZO). A case report. A 71-year-old male with HZO presented acutely to accident and emergency complaining of right vision loss, double vision and drowsiness. The right visual acuity was counting fingers. There was no relative afferent pupillary defect. He had interstitial keratitis, ptosis, proptosis and total ophthalmoplaegia. The signs indicated HZO complicated by SOFS. Brain imaging and lumbar puncture confirmed the diagnosis of varicella zoster encephalitis. Systemic acyclovir and prednisolone led to recovery of visual acuity and ocular motility in addition to resolution of his proptosis and ptosis. SOFS is a rare complication of herpes zoster infection. With the appropriate treatment and follow-up, patients may be reassured that recovery of their visual acuity and ocular motility will occur.

  19. Fissure sealant materials: Wear resistance of flowable composite resins

    PubMed Central

    Asefi, Sohrab; Eskandarion, Solmaz; Hamidiaval, Shadi

    2016-01-01

    Background. Wear resistance of pit and fissure sealant materials can influence their retention. Wear characteristics of sealant materials may determine scheduling of check-up visits. The aim of this study was to compare wear resistance of two flowable composite resins with that of posterior composite resin materials. Methods. Thirty-five disk-shaped specimens were prepared in 5 groups, including two flowable composite resins (Estelite Flow Quick and Estelite Flow Quick High Flow), Filtek P90 and Filtek P60 and Tetric N-Ceram. The disk-shaped samples were prepared in 25-mm diameter by packing them into a two-piece aluminum mold and then light-cured. All the specimens were polished for 1minute using 600-grit sand paper. The samples were stored in distilled water at room temperature for 1 week and then worn by two-body abrasion test using "pin-on-disk" method (with distilled water under a 15-Nload at 0.05 m/s, for a distance of 100 meter with Steatite ceramic balls antagonists). A Profilometer was used for evaluating the surface wear. Data were analyzed with the one-way ANOVA. Results. Estelite Flow Quick exhibited 2708.9 ± 578.1 μm2 and Estelite Flow Quick High Flow exhibited 3206 ± 2445.1 μm2of wear but there were no significant differences between the groups. They demonstrated similar wear properties. Conclusion. Estelite flowable composite resins have wear resistance similar to nano- and micro-filled and micro-hybrid composite resins. Therefore, they can be recommended as pit and fissure sealant materials in the posterior region with appropriate mechanical characteristics. PMID:27651887

  20. Fissure sealant materials: Wear resistance of flowable composite resins.

    PubMed

    Asefi, Sohrab; Eskandarion, Solmaz; Hamidiaval, Shadi

    2016-01-01

    Background. Wear resistance of pit and fissure sealant materials can influence their retention. Wear characteristics of sealant materials may determine scheduling of check-up visits. The aim of this study was to compare wear resistance of two flowable composite resins with that of posterior composite resin materials. Methods. Thirty-five disk-shaped specimens were prepared in 5 groups, including two flowable composite resins (Estelite Flow Quick and Estelite Flow Quick High Flow), Filtek P90 and Filtek P60 and Tetric N-Ceram. The disk-shaped samples were prepared in 25-mm diameter by packing them into a two-piece aluminum mold and then light-cured. All the specimens were polished for 1minute using 600-grit sand paper. The samples were stored in distilled water at room temperature for 1 week and then worn by two-body abrasion test using "pin-on-disk" method (with distilled water under a 15-Nload at 0.05 m/s, for a distance of 100 meter with Steatite ceramic balls antagonists). A Profilometer was used for evaluating the surface wear. Data were analyzed with the one-way ANOVA. Results. Estelite Flow Quick exhibited 2708.9 ± 578.1 μm(2) and Estelite Flow Quick High Flow exhibited 3206 ± 2445.1 μm(2)of wear but there were no significant differences between the groups. They demonstrated similar wear properties. Conclusion. Estelite flowable composite resins have wear resistance similar to nano- and micro-filled and micro-hybrid composite resins. Therefore, they can be recommended as pit and fissure sealant materials in the posterior region with appropriate mechanical characteristics.

  1. Pleistocene microvertebrates from fissure-fillings in Thailand

    NASA Astrophysics Data System (ADS)

    Chaimanee, Yaowalak; Jaeger, Jean-Jacques; Suteethorn, Varavudh

    Microvertebrates (and among them specially, rodents) have contributed to the elaboration of precise biochronological time scales and to the reconstitution of Pleistocene paleoenvironments in several parts of the world (North America, Africa, Europe and Japan). They have been demonstrated to be highly sensitive to climatic changes since they are very sensitive to vegetation changes. Up to now, no data is available for Southeast Asia and very few information is available concerning the nature of climatic changes which affected that part of the tropical world during the Pleistocene. In the past few years, we have discovered several fissure fillings in Thailand yielding numerous remains of microvertebrates which have been extracted by dissolution in acetic acid solution. These deposits are the result of the feeding activity of predators, like owls or diurnal raptors, whose pellets are accumulated in caves or fissures. Eleven localities, located in Central (2), Eastern (1), Western (2) and Peninsular Thailand (6) have been investigated so far. Several rodent species, belonging to 9 genera of Murinae (rats and mice) and 9 genera of Sciuridae (squirrels) have been identified in these localities. The most important differences with the extant representatives often concern the size of the teeth of these fossil species. The meaning of these size differences is not yet clearly understood since they can be attributed either to significant time differences between localities (microevolution) or as the result of size variations related to climatic changes (clinical variations). More data will have to be collected to calibrate the temporal frame. Already, important modification of the geographic distribution of some species have been discovered which testify that during the Pleistocene, significative climatic changes have affected Southeast Asia. For example, Exilisciurus, a squirrel which is presently restricted to Borneo has been recognized in Peninsular Thailand. Also, Iomys

  2. Modeling of earth fissures caused by land subsidence due to groundwater withdrawal

    NASA Astrophysics Data System (ADS)

    Panda, B. B.; Rucker, M. L.; Fergason, K. C.

    2015-11-01

    Land subsidence and earth fissures are phenomena related to groundwater withdrawal in a sedimentary basin. If the rock basement or basin lithology is irregular, both vertical and horizontal displacements can be induced due to differential settlement and tensile stresses appearing in the soil mass. If the differential settlement is of sufficient magnitude, earth fissuring can occur within tensile zones. The magnitudes of compaction and fissure geometry are closely related to the thickness and skeletal compressibility of fine-grained sediments within the aquifer system. Land subsidence and earth fissuring were modeled by employing a two-dimensional (2-D) coupled seepage and stress-strain finite element analysis. The basin bedrock geometry, lithological variation, measurements of surface displacements, and changes in hydraulic head were the critical input parameter for the subsidence modeling. Simulation results indicate that strain had exceeded the approximate threshold for fissure formation of 0.02 to 0.06 % in the area of the identified fissures. The numerical model was used to predict future subsidence and potential earth fissures for flood control structures within the metro Phoenix area.

  3. Infrasound from the 2007 fissure eruptions of Kīlauea Volcano, Hawai'i

    USGS Publications Warehouse

    Fee, D.; Garces, M.; Orr, T.; Poland, M.

    2011-01-01

    Varied acoustic signals were recorded at Kīlauea Volcano in mid-2007, coincident with dramatic changes in the volcano's activity. Prior to this time period, Pu'u 'Ō'ō crater produced near-continuous infrasonic tremor and was the primary source of degassing and lava effusion at Kīlauea. Collapse and draining of Pu'u 'Ō'ō crater in mid-June produced impulsive infrasonic signals and fluctuations in infrasonic tremor. Fissure eruptions on 19 June and 21 July were clearly located spatially and temporally using infrasound arrays. The 19 June eruption from a fissure approximately mid-way between Kīlauea's summit and Pu'u 'O'o produced infrasound for ~30 minutes-the only observed geophysical signal associated with the fissure opening. The infrasound signal from the 21 July eruption just east of Pu'u 'Ō'ō shows a clear azimuthal progression over time, indicative of fissure propagation over 12.9 hours. The total fissure propagation rate is relatively slow at 164 m/hr, although the fissure system ruptured discontinuously. Individual fissure rupture times are estimated using the acoustic data combined with visual observations.

  4. Preferential flow in fissured sediments in desert soils related to radioactive waste disposal

    SciTech Connect

    Scanlon, B.R.; Raney, J.A. . Bureau of Economic Geology)

    1992-01-01

    Unsaturated flow in fissured sediments in the Chihuahuan Desert of Texas was examined to determine if these features act as preferred pathways for water and solute transport. Fissures are surface features, or gulleys, that are underlain by fractures filled with sediment derived from surrounding areas. Hydraulic and chemical approaches were used to investigate unsaturated flow processes beneath and adjacent to fissures, and the results were compared with data from surrounding geomorphic systems such as arroyos, ephemeral streams, and interstreams. Typically, high water potentials in surficial sediments result from infiltration of recent precipitation. Below this surficial zone of high water potentials lies a zone of low water potentials that is much thinner beneath the fissure than in adjacent sediments or in sediments beneath ephemeral streams and interstreams. Maximum chloride concentrations in profiles in the near-surface fissured sediments were much lower than those measured in all other geomorphic systems. The corresponding moisture velocities in the fissured sediments ranged from 10 to 70 mm/yr. A tracer experiment demonstrated higher downward water and solute transport in the fracture fill beneath the fissure relative to adjacent sediments. Numerical simulations of the tracer experiment with the computer code TRACR3D reproduced the overall shape of the tracer plume. Sensitivity analyses demonstrated that the tracer plume is most sensitive to spatial variability in soil texture and the corresponding hydraulic parameters. The results from this study suggest that sediments in the fissured area act as preferred pathways in the shallow subsurface because surface runoff is concentrated in the fissures and because underlying fractures and cavities provide avenues for moisture and solute transport.

  5. Quantitative characterization and micro-CT mineral mapping of natural fissural enamel lesions.

    PubMed

    Shahmoradi, Mahdi; Swain, Michael V

    2016-03-01

    The aim of this study was to characterize the mineral distribution pattern of natural fissural enamel lesions and to quantify structural parameters and mineral density of these lesions in comparison to proximal white spot enamel lesions. Imaging was undertaken using a high-resolution desktop micro-computed tomography system. A calibration equation was used to transform the grey level values of images into true mineral density values. The value of lesion parameters including the mineral density and the thickness of the surface layer of the enamel lesion were extracted from mineral density profiles. The thickness of the surface layer showed variation among different lesions and it ranged from 0-90 μm in proximal lesions and 0-137 μm in fissural lesions. The average thickness of surface layer in fissural lesions was significantly higher than smooth surface proximal lesions. Sound fissural enamel showed lower mineral density compared to proximal enamel. Micro-CT and the suggested de-noising and visualization method provide an efficient high-resolution approach for non-destructive evaluation of fissural lesions. Using these methods, the current study revealed the exclusive pattern and structure of fissural enamel lesions which may provide a basis for future studies on prevention and remineralization of these lesions. The common demineralization pattern of fissural lesions, which indicates the extension of the lesion in two directions towards the pulp horns, may explain the early inflammation and symptoms of the pulp in fissural lesions even when the lesion base appears far from the pulp roof in normal radiographs. In addition, the presence of the surface layer, indicates that vigorous probing of the occlusal fissures may lead to breakage and cavitation of the enamel lesions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. A One-Year Evaluation of a Free Fissure Sealant Program.

    PubMed

    M, Bakhtiar; N, Azadi; A, Golkari

    2016-12-01

    Pit and fissure sealant therapy has been approved as an effective measure in the prevention of occlusal dental caries. Resin based materials are the most common materials used worldwide. A variety of resin based fissure sealants are produced and used. Most of them have been presented with ideal results in research environment. However, their effectiveness in the real life, especially in a mass application program such as Iran's oral health reform plan is not clear. To evaluate the longevity of different fissure sealant applied in Iran's oral health reform plan in Fars Province (south of Iran) after one year. Seven counties were selected. One hundred 6- to 8-year-old school children who had undergone fissure sealant therapy in spring 2015 were randomly selected from each county. Their first molars were examined to evaluate the status of the fissure sealants which were applied one year ago. Data on the type/brand of fissure sealant materials, type and experience of clinicians who applied them, existence of a chair-side assistant, and whether the children were caries-free at the time of fissure sealant application were collected from the existing reports. Data of 1974 teeth from 598 children were used for the final analysis. The effects of type/brand of the material was significant on the final results and remained significant (p < 0.001) after adjustments for the level of fluoride, urban/rural area, upper/lower jaw, type of clinician who applied the sealant, existence of a chair-side assistant, and child's gender, age, and being caries-free. Many factors affect the success rate of a fissure sealant therapy program. The type/brand of the material remained significantly related to the success rate of the fissure sealant even after adjustments for other influencing factors. In this study, ClinproTM Sealant (3M/ESPE, USA) showed better longevity after one year of application.

  7. Automatic segmentation of pulmonary fissures in x-ray CT images using anatomic guidance

    NASA Astrophysics Data System (ADS)

    Ukil, Soumik; Sonka, Milan; Reinhardt, Joseph M.

    2006-03-01

    The pulmonary lobes are the five distinct anatomic divisions of the human lungs. The physical boundaries between the lobes are called the lobar fissures. Detection of lobar fissure positions in pulmonary X-ray CT images is of increasing interest for the early detection of pathologies, and also for the regional functional analysis of the lungs. We have developed a two-step automatic method for the accurate segmentation of the three pulmonary fissures. In the first step, an approximation of the actual fissure locations is made using a 3-D watershed transform on the distance map of the segmented vasculature. Information from the anatomically labeled human airway tree is used to guide the watershed segmentation. These approximate fissure boundaries are then used to define the region of interest (ROI) for a more exact 3-D graph search to locate the fissures. Within the ROI the fissures are enhanced by computing a ridgeness measure, and this is used as the cost function for the graph search. The fissures are detected as the optimal surface within the graph defined by the cost function, which is computed by transforming the problem to the problem of finding a minimum s-t cut on a derived graph. The accuracy of the lobar borders is assessed by comparing the automatic results to manually traced lobe segments. The mean distance error between manually traced and computer detected left oblique, right oblique and right horizontal fissures is 2.3 +/- 0.8 mm, 2.3 +/- 0.7 mm and 1.0 +/- 0.1 mm, respectively.

  8. The Problem of Occlusal Surface Pit and Fissure Dental Caries in Naval Recruits.

    DTIC Science & Technology

    1980-06-01

    been little attention devoted to oclusal surface pit and fissure dental caries. There is so= evidence that tooth morphology is related to susceptibility...AD-A0CM 755 NAVAL DENTAL RESEARCH INST GREAT LAKES IL F/S 6/5 THE PROBLEM OF OCCLUSAL SURFACE PIT AND FISSURE DENTAL CARIES I--ETC(U) JUN 80 M R...THE PROBLEM OF OCCLUSAL SURFACE PIT AND FISSURE DENTAL CARIES IN NAVAL RECRUITS M. R. WIRTHLIN 1. L. SHKLAIR R. G. WALTER J. C. CECIL 0 M. E. COHEN

  9. Cassini VIMS Spectra of the Thermal Emission from Hot Spots Along Enceladus South Pole Fissures

    NASA Astrophysics Data System (ADS)

    Goguen, Jay D.; Buratti, Bonnie J.; Cassini VIMS Team

    2016-10-01

    Most of the south pole fissure region has not been directly illuminated by sunlight since the sub-solar point moved into the northern hemisphere in 2009, thereby eliminating the background of reflected sunlight at VIMS wavelengths and making the fissure thermal emission readily measureable. Since then, VIMS has measured spectra of at least 11 hot spots along the fissures. Most of these measurements were acquired in ride-along mode with CIRS as the prime instrument. During at least 2 encounters, VIMS and CIRS acquired simultaneous or near-simultaneous spectra of the same fissure location. VIMS spectra include multiple hot spots along Damascus, Baghdad, Cairo, and a likely hot spot on Alexandria.All of the VIMS spectra examined to date are consistent with this scenario of a self-regulating fissure maximum T~200 K with brighter VIMS emissions corresponding to fissures up to ~20 m wide. Emission from the warm fissure interior walls dominate the VIMS spectra with <15% contributed by conductive heating of the adjacent terrain at VIMS wavelengths.CIRS spectra report slightly cooler T's due to CIRS increased sensitivity to lower T emission at longer wavelengths and averaging over contributions from both the hottest and cooler areas. Combined analysis of the CIRS and VIMS spectra spanning 3 to 500 micron wavelengths promises to reveal the distribution of [T, area] near the fissures that cannot be spatially resolved. This [T, area] distribution holds the key to understanding how heat is transferred to the surface within a few 100 m of the fissures.The VIMS-detected emission is concentrated in localized hot spots along the fissures and does not seem to be distributed continuously along them. CIRS spectra suggest a more continuous distribution of the emission along the fissure length. Jets locations also are distributed along the fissure length and it appears that the VIMS-detected hot spots in general correlate with jet locations, but not all of the jet locations have been

  10. [Fissure sealants as primary preventive measures. Four-year evaluation in Stara Pazova].

    PubMed

    Andjelic, P; Pazova, S; Vojinovic, J; Tatic, E; Pintaric, J

    1991-04-01

    Worldwide studies have shown that fissure caries prophylaxis is very difficult using conventional preventive methods. The scientific council of the prophylaxis programme for the protection of mouth and teeth in Vojvodina has begun sealing fissures in Stara Pazova and Novi Sad. The molars of all 6-year-old children were sealed completely. A 77.8% reduction in fissure caries was found at the end of the four-year study. Losses of sealing material came to 16% after four years. Cost-effectiveness analysis: The sealings are three times cheaper than an amalgam filling. Application time: 8-9 minutes.

  11. Moisture and solute flux along preferred pathways characterized by fissured sediments in desert soils

    NASA Astrophysics Data System (ADS)

    Scanlon, Bridget R.

    1992-06-01

    Evaluation of preferred flow pathways is critical for waste disposal. These pathways reduce the effectiveness of thick desert soils in attenuating contaminants by short-circuiting flow through the unsaturated zone. Unsaturated flow in fissured sediments in the Chihuahuan Desert of Texas, U.S.A., was examined to determine if these sediments act as preferred pathways for water and solute transport. Fissures are surface features, or gulleys, that are underlain by fractures filled with loose sediment washed in from surrounding areas. Hydraulic and chemical approaches were used to investigate unsaturated flow processes beneath and adjacent to fissures, and the results were compared with data from surrounding geomorphic systems such as arroyos, ephemeral streams and interstreams. Typically, high water potentials in surficial sediments result from infiltration of recent precipitation. Below this surficial zone of high water potentials lies a zone of low water potentials that is much thinner beneath the fissure than in adjacent sediments or in sediments beneath ephemeral streams and interstreams. Maximum chloride concentrations in profiles in the fissured sediments (80-105 gm -3) were much lower than those measured in all other geomorphic systems (2000-6000 gm -3) because chloride is leached in the vicinity of the fissures. Minimum estimates of the moisture flux from chloride data ranged from 1 to 8 mm yr -1 in the fissured sediments and were up to 350 times greater than those calculated for ephemeral stream and interstream settings. The corresponding moisture velocities in the fissured sediments ranged from 10 to 70 mm yr -1. A tracer experiment demonstrated higher downward water and solute transport in the fracture fill beneath the fissure relative to adjacent sediments. Numerical simulations of the tracer experiment with the computer code TRACR3D reproduced the overall shape of the tracer plume. Sensitivity analyses demonstrated that the tracer plume is most sensitive

  12. Pregnancy and delivery before and after ileal pouch-anal anastomosis for inflammatory bowel disease: immediate and long-term consequences and outcomes.

    PubMed

    Hahnloser, Dieter; Pemberton, John H; Wolff, Bruce G; Larson, Dirk; Harrington, Jeffrey; Farouk, Ridzuan; Dozois, Roger R

    2004-07-01

    This study was designed to evaluate pregnancy, delivery, and functional outcome in females before and after ileal pouch-anal anastomosis for chronic ulcerative colitis. From a prospective database of 1,454 patients who underwent ileal pouch-anal anastomosis for chronic ulcerative colitis between 1981 and 1995, a standardized questionnaire was sent to all female patients aged 40 years or younger at the time of ileal pouch-anal anastomosis (n = 544). The response rate was 83 percent (450/544) with a mean follow-up after ileal pouch-anal anastomosis of 13 years. A total of 141 females were pregnant after the chronic ulcerative colitis diagnosis, but before ileal pouch-anal anastomosis (236 pregnancies; mean, 1.7) and 87 percent delivered vaginally. A mean of five (range, 1-16) years after ileal pouch-anal anastomosis, 135 females were pregnant (232 pregnancies; mean, 1.7). Comparison of pregnancy and delivery before and after ileal pouch-anal anastomosis in the same females (n = 37) showed no difference in birth weight, duration of labor, pregnancy/delivery complications, vaginal delivery rates (59 percent before vs. 54 percent after ileal pouch-anal anastomosis), and unplanned cesarean section (19 vs.14 percent). Planned cesareans occurred only after ileal pouch-anal anastomosis and were prompted by obstetrical concerns in only one of eight. Pouch function at first follow-up after delivery (mean, 7 months) was similar to pregravida function. After ileal pouch-anal anastomosis, daytime stool frequency was the same after delivery as pregravida (5.4 vs. 5.4, not significant) but was increased at the time of last follow-up (68 months after delivery; 5.4 vs. 6.4; P < 0.001). The rate of occasional fecal incontinence also was higher (20 percent after ileal pouch-anal anastomosis and 21 percent pregravida vs. 36 percent at last follow-up; P = 0.01). No difference in functional outcome was noted compared with females who were never pregnant after ileal pouch-anal anastomosis

  13. [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.

  14. Synchronous mucinous adenocarcinoma of the recto sigmoid revealed by and seeding an anal fistula. (A case report and review of the literature).

    PubMed

    Spiridakis, Konstadinos G; Sfakianakis, Elefterios E; Flamourakis, Manthos E; Intzepogazoglou, Dimitra S; Tsagataki, Eleni S; Ximeris, Nikolaos E; Rachmanis, Efstathios K; Gionis, Ioannis G; Kostakis, Giorgos E; Christodoulakis, Manousos S

    2017-01-01

    There are few cases of synchronous rectal adenocarcinoma revealed by an anal fistula. The diagnosis of synchronous mucinous adenocarcinoma of the recto sigmoid and anal canal remains difficult. The chronic anal fistula can be mistaken as the common manifestation of a benign perianal abscess or fistula. We present a rare case of a Greek Caucasian 79year old male patient with anal fistula and a recurrent perianal abscess who subsequently was found to have developed synchronous rectosigmoid and perianal mucinous adenocarcinoma on biopsy. The histological exam revealed mucinous adenocarcinoma in two sites, representing two tumors, cells were immunopositive for cytokeratin 20 and negative in cytokeratin 7. The patient underwent "laparoscopic extralevator abdominoperineal excision " with both lesions being resected. There is no recurrence after four years of follow up. This case highlights the importance of high suspicion, further investigation and the need of biopsy in all anal fistulae. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Malignant transformation in an anal condyloma acuminatum.

    PubMed

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

    1983-03-01

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

  16. [Initial pretherapeutic assessment of anal epidermoid carcinoma].

    PubMed

    de Parades, Vincent; Bauer, Pierre; Benbunan, Jean-Louis; Bouillet, Thierry; Cottu, Paul-Henri; Cuenod, Charles-André; Durdux, Catherine; Fléjou, Jean-François; Atienza, Patrick

    2007-02-01

    Anal epidermoid carcinoma is a rare malignant tumor, comprising less than 5% of all carcinomas of the colon, rectum, and anus. The primary therapy now includes radiotherapy, often in combination with chemotherapy. Radical surgery is now rarely indicated. Therapeutic indications are based on locoregional staging, the presence of visceral metastases and an evaluation of the medical history. Anorectal endosonography is helpful in evaluating locoregional extension. In addition, magnetic resonance imaging, positron emission tomography scanning and inguinal sentinel lymph node procedure should play a role in a more selective approach in patients with anal carcinoma.

  17. Painless Ulcers and Fissures of Toes: Hereditary Sensory Neuropathy, Not Leprosy

    PubMed Central

    Rao, Angoori Gnaneshwar

    2016-01-01

    Hereditary sensory neuropathies (HSN) are rare genetically determined neuropathies. They often manifest as painless injuries in children. We present HSN in a 5-year-old boy who presented with recurrent fissuring and ulceration involving both great toes. PMID:26955138

  18. Painless Ulcers and Fissures of Toes: Hereditary Sensory Neuropathy, Not Leprosy.

    PubMed

    Rao, Angoori Gnaneshwar

    2016-01-01

    Hereditary sensory neuropathies (HSN) are rare genetically determined neuropathies. They often manifest as painless injuries in children. We present HSN in a 5-year-old boy who presented with recurrent fissuring and ulceration involving both great toes.

  19. Putative fissure-resistance QTLs mapped to chromosomes 1 and 8 based on allelic frequency differences observed between fissure-resistant and fissure-susceptible progeny from two segregating populations

    USDA-ARS?s Scientific Manuscript database

    Whole rice kernels have two to three times more market value than broken, which means that any reduction in milling yield results in financial losses for both rice producers and millers. One of the primary causes of rice breakage during milling is fissuring of the rice before it even enters the mil...

  20. Fluoride: Is It Worth to be added in Pit and Fissure Sealants?

    PubMed Central

    Dahake, Prasanna T; Raju, OS; Basappa, N

    2012-01-01

    ABSTRACT Background and objectives: Fluoride is being used for the prevention of dental caries since a long time. Incorporation of fluoride in pit and fissure sealants has been found to reduce initiation and progression of pit and fissure caries. Authors conducted this study to evaluate and compare the effect of fluoride releasing pit and fissure sealants on the inhibition of demineralization of adjacent enamel and to reduce wall lesion frequency. Materials and methods: A total of 60 caries-free human third molars were randomly assigned into three groups receiving conventional resin sealant without fluoride (Group A), fluoride releasing resin sealant (Group B), glass ionomer pit and fissure sealant (Group C). Fissure cavities of 5 × 2 × 1.5 mm were prepared on buccal surfaces of teeth using fissurotomy bur and sealants were applied onto the cavities. The teeth were then thermocycled and exposed to acidified gelatin gel for 6 weeks to induce caries like lesions. A 150 μ m section was taken from each tooth and observed under polarized light microscope to measure the depth of advancing front of outer enamel lesion. The outer lesion depths of all three groups were compared. Results: Enamel demineralization was least in glass ionomer pit and fissure sealant while the demineralization exhibited by nonfluoridated resin and fluoridated resin were comparable. Wall lesion frequency was found to be 0% in all groups. Conclusion and interpretation: The glass ionomer pit and fissure sealant exhibited highest anticariogenic efficacy and hence can be advocated as a means of preventing dental caries. How to cite this article: Prabhakar AR, Dahake PT, Raju OS, Basappa N. Fluoride: Is It Worth to be added in Pit and Fissure Sealants?. Int J Clin Pediatr Dent 2012;5(1):1-5. PMID:25206126

  1. Orientation of the eruption fissures controlled by a shallow magma chamber in Miyakejima

    NASA Astrophysics Data System (ADS)

    Geshi, Nobuo; Oikawa, Teruki

    2016-11-01

    Orientation of the eruption fissures and composition of the lavas of the Miyakejima volcano indicate tectonic influence of a shallow magma chamber on the distribution of eruption fissures. We examined the distributions and magmatic compositions of 23 fissures that formed within the last 2800 years, based on a field survey and a new dataset of 14C ages. The dominant orientation of the eruption fissures in the central portion of the volcano was found to be NE-SW, which is perpendicular to the direction of regional maximum horizontal compressive stress (σHmax). Magmas that show evidences of magma mixing between basaltic and andesitic magmas erupted mainly from the eruption fissures with a higher offset angle from the regional σHmax direction. The presence of a shallow dike-shaped magma chamber controls the distribution of the eruption fissures. The injection of basaltic magma into the shallow andesitic magma chamber caused the temporal rise of internal magmatic pressure in the shallow magma chamber. Dikes extending from the andesitic magma chamber intrude along the local compressive stress field which is generated by the internal excess pressure of the andesitic magma chamber. As the result, the eruption fissures trend parallel to the elongation direction of the shallow magma chamber. Injection of basaltic magma into the shallow andesitic magma chamber caused the magma mixing. Some basaltic dikes from the deep-seated magma chamber reach the ground surface without intersection with the andesitic magma chamber. The patterns of the eruption fissures can be modified in the future as was observed in the case of the destruction of the shallow magma chamber during the 2000 AD eruption.

  2. Fluorine mapping in sound and carious fissures of human teeth using PIGE

    NASA Astrophysics Data System (ADS)

    Yamamoto, H.; Nomachi, M.; Yasuda, K.; Iwami, Y.; Ebisu, S.; Sakai, T.; Fukuda, M.

    2005-04-01

    By using the PIGE technique at JAERI Takasaki, we measured fluorine (F) distribution in a micro area of occlusal fissures in the enamel of human teeth. The fissures were classified into three groups: Group I, no caries; Group II, incipient caries; Group III, advanced caries. The extracted teeth were embedded in epoxy resin and cut along the longitudinal axis through the fissures. The F concentration in the fissure at the cut surface was measured. A 1.7 MeV proton beam accelerated by the TIARA single-ended accelerator was delivered to a micro-beam apparatus. The beam spot size was about 1 μm with a beam current of about 100 pA. A nuclear reaction, 19F (p,αγ)16O, was used to measure the F concentration and gamma-rays from this reaction were detected with a 4″ NaI(Tl) detector. X-rays induced by proton were detected with a Ge detector to measure calcium concentration and the beam intensity was monitored with the X-ray yield from a copper foil for quantitative analysis. The obtained results were shown as two-dimensional mapping. In all specimens, an F concentration was observed around the fissure. The F concentration varied depending on the location of the fissure and decreased towards the inner part of the tooth. The maximum F concentration values in the measured area ranged from 3500-11700 ppm (mean = 6000 ppm) in Group I, 2400-10700 ppm (mean = 6300 ppm) in Group II, and 5200-16900 ppm (mean = 9300 ppm) in Group III. Although high F concentrations tended to be measured in the carious fissures, high values were also recognized in the sound fissures. More studies are necessary to clarify the relationship between F and carious lesions.

  3. Cadherin-mediated cell adhesion is critical for the closing of the mouse optic fissure.

    PubMed

    Chen, Shuyi; Lewis, Brandy; Moran, Andrea; Xie, Ting

    2012-01-01

    Coloboma is a congenital disease that contributes significantly to childhood blindness. It results from the failure in closing the optic fissure, a transient opening on the ventral side of the developing eye. Although human and mouse genetic studies have identified a number of genes associated with coloboma, the detailed cellular mechanisms underlying the optic fissure closure and coloboma formation remain largely undefined. N-cadherin-mediated cell adhesion has been shown to be important for the optic fissure closure in zebrafish, but it remains to be determined experimentally how cell-cell adhesions are involved in the mammalian optic fissure closing process. α-Catenin is required for cell adhesion mediated by all of the classic cadherin molecules, including N-cadherin. In this study, we used the Cre-mediated conditional knockout technique to specifically delete α-catenin from the developing mouse eye to show that it is required for the successful closing of the optic fissure. In α-catenin conditional mutant optic cups, the major cell fates, including the optic fissure margin, neural retina and retinal pigmented epithelium, are specified normally, and the retinal progenitor cells proliferate normally. However, adherens junctions components, including N-cadherin, β-catenin and filamentous actin, fail to accumulate on the apical side of α-catenin mutant retinal progenitor cells, where adherens junctions are normally abundant, and the organization of the neural retina and the optic fissure margin is disrupted. Finally, the α-catenin mutant retina gradually degenerates in the adult mouse eye. Therefore, our results show that α-catenin-mediated cell adhesion and cell organization are important for the fissure closure in mice, and further suggest that genes that regulate cell adhesion may underlie certain coloboma cases in humans.

  4. Mechanical benefits of conservative restoration for dental fissure caries.

    PubMed

    Zhang, Zhongpu; Zheng, Keke; Li, Eric; Li, Wei; Li, Qing; Swain, Michael V

    2016-01-01

    The principle of minimal intervention dentistry (MID) is to limit removal of carious tooth tissue while maximizing its repair and survival potential. The objective of this study is to explore the fracture resistance of a permanent molar tooth with a fissure carious lesion along with three clinical restoration procedures, namely one traditional and two conservative approaches, based upon MID. The traditional restoration employs extensive surgical removal of enamel and dentine about the cavity to eliminate potential risk of further caries development, while conservative method #1 removes significantly less enamel and infected dentine, and conservative method #2 only restores the overhanging enamel above the cavity and leaves the infected and affected dentine as it was. An extended finite element method (XFEM) is adopted here to analyze the fracture behaviors of both two-dimensional (2D) and three-dimensional (3D) modeling of these four different scenarios. It was found that the two conservative methods exhibited better fracture resistance than the traditional restorative method. Although conservative method #2 has less fracture resistance than method #1, it had significantly superior fracture resistance compared to other restorations. More important, after cavity sealing it may potentially enhance the opportunity for remineralization and improved loading bearing capacity and fracture resistance.

  5. A study on using texture analysis methods for identifying lobar fissure regions in isotropic CT images.

    PubMed

    Wei, Q; Hu, Y

    2009-01-01

    The major hurdle for segmenting lung lobes in computed tomographic (CT) images is to identify fissure regions, which encase lobar fissures. Accurate identification of these regions is difficult due to the variable shape and appearance of the fissures, along with the low contrast and high noise associated with CT images. This paper studies the effectiveness of two texture analysis methods - the gray level co-occurrence matrix (GLCM) and the gray level run length matrix (GLRLM) - in identifying fissure regions from isotropic CT image stacks. To classify GLCM and GLRLM texture features, we applied a feed-forward back-propagation neural network and achieved the best classification accuracy utilizing 16 quantized levels for computing the GLCM and GLRLM texture features and 64 neurons in the input/hidden layers of the neural network. Tested on isotropic CT image stacks of 24 patients with the pathologic lungs, we obtained accuracies of 86% and 87% for identifying fissure regions using the GLCM and GLRLM methods, respectively. These accuracies compare favorably with surgeons/radiologists' accuracy of 80% for identifying fissure regions in clinical settings. This shows promising potential for segmenting lung lobes using the GLCM and GLRLM methods.

  6. Differential outcome of fissure-positioned tube in closed thoracostomy for primary spontaneous pneumothorax.

    PubMed

    Kim, Yong Won; Byun, Chun Sung; Cha, Yong Sung; Kim, Oh Hyun; Lee, Kang Hyun; Park, Il Hwan

    2015-05-01

    Closed tube thoracostomy is often used to evacuate a primary spontaneous pneumothorax (PSP). Occasionally, this procedure is complicated by placement of the chest tube location in the fissural area instead of pleural space. There is a paucity of studies on outcomes according to chest tube placement. As such, we investigated outcomes of chest tube placement in fissural versus pleural area in closed thoracostomy for PSP. Patients between 14 and 65 years of age who had been treated with chest tube insertion to evacuate PSP were selected based on retrospective review of medical records. Patients selected for this study received chest tube placement at either the fissural or pleural spaces. Those with pre-existing lung disease or those transferred into our hospital after closed thoracostomy were excluded. Of the 255 patients with PSP treated with chest tube insertion, 172 patients were enrolled in this study. Twenty-nine (16.9%) had fissural tube placement and 143 (83.1%) had pleural tube placement. A higher proportion of patients in the fissural versus pleural group required additional chest tube insertion (20.7% vs 4.9%, P = 0.010, respectively). There was no significant difference in body mass index, smoker status, symptom duration, number of episodes, post-thoracostomy complications, need for subsequent management, and duration of hospitalization in either group. In closed thoracostomy for PSP, there is a higher chance of tube dysfunction when the chest tube is positioned at fissural area as compared with the pleural space.

  7. Monitoring on Xi'an ground fissures deformation with TerraSAR-X data

    USGS Publications Warehouse

    Zhao, C.; Zhang, Q.; Zhu, W.; Lu, Zhiming

    2012-01-01

    Owing to the fine resolution of TerraSAR-X data provided since 2007, this paper applied 6 TerraSAR data (strip mode) during 3rd Dec. 2009 to 23rd Mar. 2010 to detect and monitor the active fissures over Xi'an region. Three themes have been designed for high precision detection and monitoring of Xi'an-Chang'an fissures, as small baseline subsets (SBAS) to test the atmospheric effects of differential interferograms pair stepwise, 2-pass differential interferogram with very short baseline perpendicular to generate the whole deformation map with 44 days interval, and finally, corner reflector (CR) technique was used to closely monitor the relative deformation time series between two CRs settled crossing two ground fissures. Results showed that TerraSAR data are a good choice for small-scale ground fissures detection and monitoring, while special considerations should be taken for their great temporal and baseline decorrelation. Secondly, ground fissures in Xi'an were mostly detected at the joint section of stable and deformable regions. Lastly, CR-InSAR had potential ability to monitor relative deformation crossing fissures with millimeter precision.

  8. 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…

  9. 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…

  10. 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.

  11. 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.

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

    PubMed

    Meinero, Piercarlo; Mori, Lorenzo; Gasloli, Giorgio

    2014-03-01

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

  13. Quality of life with anal fistula

    PubMed Central

    Owen, HA; Buchanan, GN; Schizas, A; Cohen, R; Williams, AB

    2016-01-01

    Introduction Anal fistula affects people of working age. Symptoms include abscess, pain, discharge of pus and blood. Treatment of this benign disease can affect faecal continence, which may, in turn, impair quality of life (QOL). We assessed the QOL of patients with cryptoglandular anal fistula. Methods Newly referred patients with anal fistula completed the St Mark’s Incontinence Score, which ranges from 0 (perfect continence) to 24 (totally incontinent), and Short form 36 (SF–36) questionnaire at two institutions with an interest in anal fistula. The data were examined to identify factors affecting QOL. Results Data were available for 146 patients (47 women), with a median age of 44 years (range 18–82 years) and a median continence score of 0 (range 0–23). Versus population norms, patients had an overall reduction in QOL. While those with recurrent disease had no difference on continence scores, QOL was worse on two of eight SF–36 domains (p<0.05). Patients with secondary extensions had reduced QOL in two domains (p<0.05), while urgency was associated with reduced QOL on five domains (p<0.05). Patients with loose seton had the same QOL as those without seton. No difference in urgency was found between patients with and without loose seton. In primary fistula patients, 19.4% of patients experienced urgency versus 36.3% of those with recurrent fistulas. Conclusions Patients with anal fistula had a reduced QOL, which was worse in those with recurrent disease, secondary extensions and urgency. Loose seton had no impact on QOL. PMID:27087327

  14. Quality of life with anal fistula.

    PubMed

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

    2016-05-01

    Anal fistula affects people of working age. Symptoms include abscess, pain, discharge of pus and blood. Treatment of this benign disease can affect faecal continence, which may, in turn, impair quality of life (QOL). We assessed the QOL of patients with cryptoglandular anal fistula. Newly referred patients with anal fistula completed the St Mark's Incontinence Score, which ranges from 0 (perfect continence) to 24 (totally incontinent), and Short form 36 (SF-36) questionnaire at two institutions with an interest in anal fistula. The data were examined to identify factors affecting QOL. Data were available for 146 patients (47 women), with a median age of 44 years (range 18-82 years) and a median continence score of 0 (range 0-23). Versus population norms, patients had an overall reduction in QOL. While those with recurrent disease had no difference on continence scores, QOL was worse on two of eight SF-36 domains (p<0.05). Patients with secondary extensions had reduced QOL in two domains (p<0.05), while urgency was associated with reduced QOL on five domains (p<0.05). Patients with loose seton had the same QOL as those without seton. No difference in urgency was found between patients with and without loose seton. In primary fistula patients, 19.4% of patients experienced urgency versus 36.3% of those with recurrent fistulas. Patients with anal fistula had a reduced QOL, which was worse in those with recurrent disease, secondary extensions and urgency. Loose seton had no impact on QOL.

  15. 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,…

  16. 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,…

  17. [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).

  18. Ozone Treatment for Chronic Anal Fistula: It Is Not Promising.

    PubMed

    Ozturk, Alaattin; Atalay, Talha; Cipe, Gokhan; Luleci, Nurettin

    2017-08-01

    The aim of this study is to assess the effect of ozone gas in the treatment of anorectal fistulae. The tip of a 20 G intravenous cannula was inserted from the fistula orifice. Medical ozone was introduced into the fistula. A total of 10 sessions of ozone gas insufflation was performed on alternate days. Treatment was considered to be successful if fistula discharge ceased and the outer fistula orifice closed; however, if discharge was continued or outer fistula orifice was open, the treatment considered to be failed. A total of 12 adult patients were included in the study. The fistula was closed in three patients (25 %), in nine patients (75 %) without closure. In one patient who had fistula closure, the fistula recurred after 2 months. Patients did not express any discomfort during ozone insufflation. There were no side effects or complications due to ozone insufflation. The success rate of ozone insufflation in anorectal fistulae closure is low.

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

    PubMed

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

    2015-12-01

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

  20. Long-term outcome of the anal fistula plug for anal fistula of cryptoglandular origin.

    PubMed

    Tan, K-K; Kaur, G; Byrne, C M; Young, C J; Wright, C; Solomon, M J

    2013-12-01

    This study aimed to evaluate the long-term outcome of the anal fistula plug in the treatment of anal fistula of cryptoglandular origin. A review of all patients who had at least one anal fistula plug inserted from March 2007 to August 2008 was performed. Only anal fistulae of cryptoglandular origin were included. Success was defined as the closure of the external opening with no further purulent discharge or collection. Thirty anal fistula plugs were inserted in 26 patients [median age 40 (26-70) years]. Twenty-six of the fistulae were transsphincteric and three were suprasphincteric. One patient had a high intersphincteric fistula, which was the only fistula that did not have a seton inserted. The median duration between seton insertion and the plug procedure was 12 (4-28) weeks. The median length of the fistula tract was 3 (1-7.5) cm. After a median follow-up of 59 (13-97) weeks, 26 (86.7%) fistulae recurred. Of the 26 failures, the median time to failure was 8 (2-54) weeks. Subsequent surgical interventions were performed in 20 of the failures. The role of the fistula plug in the management of anal fistula of cryptoglandular origin remains debatable and warrants further evaluation. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

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

    PubMed

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

    2017-04-30

    BACKGROUND Although many attempts have been made to advance the treatment of complex anal fistula, it continues to be a difficult surgical problem. This study aimed to describe the novel technique of video-assisted anal fistula treatment (VAAFT) and our preliminary experiences using VAAFT with patients with complex anal fistula. MATERIAL AND METHODS From May 2015 to May 2016, 52 patients with complex anal fistula were treated with VAAFT at Yangpu Hospital of Tongji University School of Medicine, and the clinical data of these patients were reviewed. RESULTS VAAFT was performed successfully in all 52 patients. The median operation time was 55 minutes. Internal openings were identified in all cases. 50 cases were closed with sutures, and 2 were closed with staplers. Complications included perianal sepsis in 3 cases and bleeding in another 3 cases. Complete healing without recurrence was achieved in 44 patients (84.6%) after 9 months of follow-up. No fecal incontinence was observed. Furthermore, a significant improvement in Gastrointestinal Quality of Life Index (GIQLI) score was observed from preoperative baseline (mean, 85.5) to 3-month follow-up (mean, 105.4; p<0.001), and this increase was maintained at 9-months follow-up (mean, 109.6; p<0.001). CONCLUSIONS VAAFT is a safe and minimally invasive technique for treating complex anal fistula with preservation of anal sphincter function.

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

    PubMed Central

    Jiang, Hui-hong; Liu, Hai-long; Li, Zhen; Xiao, Yi-hua; Li, A-jian; Chang, Yi; Zhang, Yong; Lv, Liang; Lin, Mou-bin

    2017-01-01

    Background Although many attempts have been made to advance the treatment of complex anal fistula, it continues to be a difficult surgical problem. This study aimed to describe the novel technique of video-assisted anal fistula treatment (VAAFT) and our preliminary experiences using VAAFT with patients with complex anal fistula. Material/Methods From May 2015 to May 2016, 52 patients with complex anal fistula were treated with VAAFT at Yangpu Hospital of Tongji University School of Medicine, and the clinical data of these patients were reviewed. Results VAAFT was performed successfully in all 52 patients. The median operation time was 55 minutes. Internal openings were identified in all cases. 50 cases were closed with sutures, and 2 were closed with staplers. Complications included perianal sepsis in 3 cases and bleeding in another 3 cases. Complete healing without recurrence was achieved in 44 patients (84.6%) after 9 months of follow-up. No fecal incontinence was observed. Furthermore, a significant improvement in Gastrointestinal Quality of Life Index (GIQLI) score was observed from preoperative baseline (mean, 85.5) to 3-month follow-up (mean, 105.4; p<0.001), and this increase was maintained at 9-months follow-up (mean, 109.6; p<0.001). Conclusions VAAFT is a safe and minimally invasive technique for treating complex anal fistula with preservation of anal sphincter function. PMID:28456815

  3. Multiscale Strain as a Predictor of Impact-Induced Fissuring in Articular Cartilage.

    PubMed

    Henak, Corinne R; Bartell, Lena R; Cohen, Itai; Bonassar, Lawrence J

    2017-03-01

    Mechanical damage is central to both initiation and progression of osteoarthritis (OA). However, specific causal links between mechanics and cartilage damage are incompletely understood, which results in an inability to predict failure. The lack of understanding is primarily due to the difficulty in simultaneously resolving the high rates and small length scales relevant to the problem and in correlating such measurements to the resulting fissures. This study leveraged microscopy and high-speed imaging to resolve mechanics on the previously unexamined time and length scales of interest in cartilage damage, and used those mechanics to develop predictive models. The specific objectives of this study were to: first, quantify bulk and local mechanics during impact-induced fissuring; second, develop predictive models of fissuring based on bulk mechanics and local strain; and third, evaluate the accuracy of these models in predicting fissures. To achieve these three objectives, bovine tibial cartilage was impacted using a custom spring-loaded device mounted on an inverted microscope. The occurrence of fissures was modulated by varying impact energy. For the first objective, during impact, deformation was captured at 10,000 frames per second and bulk and local mechanics were analyzed. For the second objective, data from samples impacted with a 1.2 mm diameter rod were fit to logistic regression functions, creating models of fissure probability based on bulk and local mechanics. Finally, for the third objective, data from samples impacted with a 0.8 mm diameter rod were used to test the accuracy of model predictions. This study provides a direct comparison between bulk and local mechanical thresholds for the prediction of fissures in cartilage samples, and demonstrates that local mechanics provide more accurate predictions of local failure than bulk mechanics provide. Bulk mechanics were accurate predictors of fissure for the entire sample cohort, but poor predictors

  4. [Clinical evaluation of fluor protector and glass-ionomer cement used as pit and fissure sealant for preventing pit and fissure caries in children].

    PubMed

    Ji, Pei-hong; Xu, Quan-lin; Ba, Yong

    2007-08-01

    To study the clinical effect of the fluor protector and glass-ionomer cement used as pit and fissure sealant for preventing pit and fissure caries in children. 622 health permanent teeth in 6-8 years old children were divided into three groups. Children in the experimental group A (n=207,335 teeth) underwent fluor protector every six months, experimental group B(n=205, 327 teeth) with glass-ionomer cement used as pit and fissure sealant and children in the control group(n=210, 354 teeth) underwent no treatment. The incidence of caries were compared among the three groups using SPSS10.0 software package after 3 years. After 3 years, the incidence of caries in A and B experimental groups were lower than in the control group, the difference was significant (P<0.01), but there were no significant difference between group A and group B (P>0.05). Fluor protector and glass-ionomer cement used as pit and fissure sealant also have good clinical effect in preventing caries.

  5. 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

  6. 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

  7. Retention and effectiveness of fissure sealants in Kuwaiti school children.

    PubMed

    Francis, R; Mascarenhas, A K; Soparkar, P; Al-Mutawaa, S

    2008-12-01

    To evaluate the retention and effectiveness of fissure sealants in permanent first molars in a public programme. Sealant retention in permanent first molars was evaluated in 452 children aged 6-8 years in 20 primary schools under the care of the School Oral Health Programme, Kuwait-Forsyth. The sealants were placed using rubber dam or cotton roll isolation, after cleaning with pumice and rubber cup, and 15 seconds etching. Sealant retention was evaluated at one and two years and scored as complete, partial or complete loss of sealant. Caries was scored when sealant was partially or completely lost. A total of 2,744 sealants were applied, with 2,324 and 2,288 sealants examined at the end of the first and second year respectively. In two years, 75% of the sealants were completely retained, 2.9% partially lost, 7.3% completely lost, and 14.8% resealed or restored. A small proportion of teeth (0.9%) were carious. Multivariate analyses showed that occlusal surfaces were 2.8 times more likely to retain a sealant than the buccal and palatal pits (95% CI 2.7-3.9, p<0.0001), and maxillary teeth were 1.3 times more likely to retain their sealant than the mandibular teeth (95% CI 1.01-1.5, p=0.04). Maxillary teeth were less likely to be carious (OR=0.6, 95% CI 0.4-0.97), p=0.03) and occlusal surfaces were 2.8 times more likely to be carious (95% CI 1.9-4.3), p<0.0001). No differences in sealant retention (p=0.24) and caries (p=0.19) were seen between teeth isolated using rubberdam or cotton roll. Sealant retention was high, and sealants were effective in preventing caries.

  8. [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.

  9. Retention of resin-based filled and unfilled pit and fissure sealants: A comparative clinical study.

    PubMed

    Reddy, V Rajashekar; Chowdhary, Nagalakshmi; Mukunda, K S; Kiran, N K; Kavyarani, B S; Pradeep, M C

    2015-03-01

    The most caries-susceptible period of a permanent first molar tooth is the eruption phase, during which the enamel is not fully matured and it is usually difficult for the child to clean the erupting tooth surfaces. Sealing occlusal pits and fissures with resin-based pit and fissure sealants is a proven method to prevent occlusal caries. The difference in the viscosity of the sealants differs in the penetration into pit and fissures and abrasive wear resistance property due to the addition of filler particles. The present study was conducted to evaluate and compare the retention of the resin-based filled (Helioseal F, Ivoclar Vivadent) and unfilled (Clinpro, 3M ESPE) pit and fissure sealants, which is important for their effectiveness. Fifty-six children between the age group of 6 and 9 years, with all four newly erupted permanent first molars were selected. Sealants were applied randomly using split mouth design technique on permanent first molars. Evaluation of sealant retention was performed at regular intervals over 12 months, using Simonsen's criteria at 2(nd), 4(th), 6(th), 8(th), 10(th) and 12(th) month. The results were subjected to statistical analysis. At the end of our study period (12(th) month), 53.57% showed complete retention, 37.50% showed partial retention, and 8.83% showed complete missing of resin-based filled (Helioseal F) pit and fissure sealant. And, 64.29% showed complete retention, 32.14% showed partial retention, and 3.57% showed complete missing of resin-based unfilled (Clinpro) pit and fissure sealant. This difference in retention rates between filled and unfilled pit and fissure sealants was not statistically significant. The difference in retention rates between Helioseal F and Clinpro was not statistically significant, but Clinpro (unfilled) sealant showed slightly higher retention rates and clinically better performance than Helioseal F (filled).

  10. Comparison of various concentrations of tricalcium phosphate nanoparticles on mechanical properties and remineralization of fissure sealants.

    PubMed

    Tavassoli-Hojjati, Sara; Atai, Mohammad; Haghgoo, Roza; Rahimian-Imam, Sara; Kameli, Somayeh; Ahmaian-Babaki, Fatemeh; Hamzeh, Faezeh; Ahmadyar, Maryam

    2014-07-01

    The aim of this study was to investigate the mechanical properties (flexural strength, micro-shear bond strength) and remineralizing potential of fissure sealants by adding various concentrations of β-tricalcium phosphate nanoparticles. This in-vitro study consisted of five experimental groups containing prepared nano-fisssure sealants (1-5 wt.% β-TCP nanoparticles) and two control groups containing a prepared and a commercial fissure sealant. Flexural/micro-shear bond strength values were measured using Zwick test machine. Cavities on sixty healthy premolar teeth were filled with the fissure sealants containing 0-5 wt.% of nano β-TCP. The samples were assessed for remineralization under scanning electron microscopy (SEM) and EDAX. Kolmogorov-Smirnov test, One-way ANOVA and Tukey's Post Hoc analysis/HSD were used to analyze the data. There was no significant difference between the flexural strengths/elastic modulus of the 0-5 wt.% nano β-TCP groups (p>0.05). The average flexural strength/elastic modulus of the prepared fissure sealant group (0%) was significantly higher than the commercial fissure sealant group (Clinpro) (p<0.05). There was no significant difference between micro-shear bond strengths of the experimental groups (1-5 wt.%), and between the commercial and the prepared (0%) fissure sealant groups (p>0.05). Examining the samples under SEM showed a significant increase in thickness of the intermediate layer with increasing concentrations of β-TCP nanoparticles (p<0.05). Addition of 1-5 wt.% β-TCP nanoparticles to the fissure sealants significantly increased the remineralization potential without affecting the mechanical properties.

  11. Retention of resin-based filled and unfilled pit and fissure sealants: A comparative clinical study

    PubMed Central

    Reddy, V. Rajashekar; Chowdhary, Nagalakshmi; Mukunda, K. S.; Kiran, N. K.; Kavyarani, B. S.; Pradeep, M. C.

    2015-01-01

    Background and Objectives: The most caries-susceptible period of a permanent first molar tooth is the eruption phase, during which the enamel is not fully matured and it is usually difficult for the child to clean the erupting tooth surfaces. Sealing occlusal pits and fissures with resin-based pit and fissure sealants is a proven method to prevent occlusal caries. The difference in the viscosity of the sealants differs in the penetration into pit and fissures and abrasive wear resistance property due to the addition of filler particles. The present study was conducted to evaluate and compare the retention of the resin-based filled (Helioseal F, Ivoclar Vivadent) and unfilled (Clinpro, 3M ESPE) pit and fissure sealants, which is important for their effectiveness. Materials and Methods: Fifty-six children between the age group of 6 and 9 years, with all four newly erupted permanent first molars were selected. Sealants were applied randomly using split mouth design technique on permanent first molars. Evaluation of sealant retention was performed at regular intervals over 12 months, using Simonsen's criteria at 2nd, 4th, 6th, 8th, 10th and 12th month. The results were subjected to statistical analysis. Results: At the end of our study period (12th month), 53.57% showed complete retention, 37.50% showed partial retention, and 8.83% showed complete missing of resin-based filled (Helioseal F) pit and fissure sealant. And, 64.29% showed complete retention, 32.14% showed partial retention, and 3.57% showed complete missing of resin-based unfilled (Clinpro) pit and fissure sealant. This difference in retention rates between filled and unfilled pit and fissure sealants was not statistically significant. Conclusion: The difference in retention rates between Helioseal F and Clinpro was not statistically significant, but Clinpro (unfilled) sealant showed slightly higher retention rates and clinically better performance than Helioseal F (filled). PMID:25821368

  12. Adhesive systems under fissure sealants: yes or no?: A systematic review and meta-analysis.

    PubMed

    Bagherian, Ali; Sarraf Shirazi, Alireza; Sadeghi, Ramin

    2016-06-01

    The authors of this systematic review and meta-analysis had 2 aims: to evaluate fissure sealant retention with and without the use of an adhesive system and to compare fissure sealant retention using etch-and-rinse adhesive systems versus self-etching adhesive systems. The authors conducted a literature search (all articles published through November 1, 2015) to identify studies for inclusion in this systematic review. They assessed the quality of the evidence provided using the modified Jadad scale and performed meta-analyses using a random-effects model. The authors considered 12 studies that met the inclusion criteria for the systematic review. In addition, they used 5 of 9 studies related to the first part of the study and 3 of 4 studies related to the second part of the study that met the inclusion criteria for meta-analysis. In the analysis of the first part of the systematic review, the authors found that adhesive systems had a significant positive effect on fissure sealant (odds ratio, 3.294; 95% confidence interval, 1.292-8.401; P = .013). In the analysis of the second part of the systematic review, the authors found that etch-and-rinse adhesives were superior to self-etching adhesives in the fissure sealant procedure (odds ratio, 14.569; 95% confidence interval, 2.616-81.131; P = .002). The use of adhesive systems beneath fissure sealants can increase the retention of fissure sealants. Also, when adhesive systems are used with fissure sealants, etch-and-rinse systems are preferable. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

  13. Comparison of Various Concentrations of Tricalcium Phosphate Nanoparticles on Mechanical Properties and Remineralization of Fissure Sealants

    PubMed Central

    Tavassoli-Hojjati, Sara; Atai, Mohammad; Haghgoo, Roza; Rahimian-Imam, Sara; Kameli, Somayeh; Ahmaian-Babaki, Fatemeh; Hamzeh, Faezeh; Ahmadyar, Maryam

    2014-01-01

    Objective: The aim of this study was to investigate the mechanical properties (flexural strength, micro-shear bond strength) and remineralizing potential of fissure sealants by adding various concentrations of β-tricalcium phosphate nanoparticles. Materials and Methods: This in-vitro study consisted of five experimental groups containing prepared nano-fisssure sealants (1–5 wt.% β-TCP nanoparticles) and two control groups containing a prepared and a commercial fissure sealant. Flexural/micro-shear bond strength values were measured using Zwick test machine. Cavities on sixty healthy premolar teeth were filled with the fissure sealants containing 0–5 wt.% of nano β-TCP. The samples were assessed for remineralization under scanning electron microscopy (SEM) and EDAX. Kolmogorov-Smirnov test, One-way ANOVA and Tukey’s Post Hoc analysis/HSD were used to analyze the data. Results: There was no significant difference between the flexural strengths/elastic modulus of the 0–5 wt.% nano β-TCP groups (p>0.05). The average flexural strength/elastic modulus of the prepared fissure sealant group (0%) was significantly higher than the commercial fissure sealant group (Clinpro) (p<0.05). There was no significant difference between micro-shear bond strengths of the experimental groups (1–5 wt.%), and between the commercial and the prepared (0%) fissure sealant groups (p>0.05). Examining the samples under SEM showed a significant increase in thickness of the intermediate layer with increasing concentrations of β-TCP nanoparticles (p<0.05). Conclusion: Addition of 1–5 wt.% β-TCP nanoparticles to the fissure sealants significantly increased the remineralization potential without affecting the mechanical properties. PMID:25584048

  14. Functional morphology of anal sphincter complex unveiled by high definition anal manometery and three dimensional ultrasound imaging.

    PubMed

    Raizada, V; Bhargava, V; Karsten, A; Mittal, R K

    2011-11-01

    Anal sphincter complex consists of anatomically overlapping internal anal sphincter (IAS), external anal sphincter (EAS) and puborectalis muscle (PRM). We determined the functional morphology of anal sphincter muscles using high definition anal manometery (HDAM), three dimensional (3D)-ultrasound (US) and Magnetic resonance (MR) imaging. We studied 15 nulliparous women. High definition anal manometery probe equipped with 256 pressure transducers was used to measure the anal canal pressures at rest and squeeze. Lengths of IAS, PRM, and EAS were determined from the 3D-US images and superimposed on the HDAM plots. Movements of anorectal angle with squeeze were determined from the dynamic MR images. High definition anal manometery plots reveal that anal canal pressures are highly asymmetric in the axial and circumferential direction. Anal canal length determined by the 3D-US images is slightly smaller than that measured by HDAM. The EAS (1.9 ± 0.5 cm long) and PRM (1.7 ± 0.4 cm long) surround distal and proximal parts of the anal canal, respectively. With voluntary contraction, anal canal pressures increase in the proximal (PRM) and distal (EAS zone) parts of anal canal. Posterior peak pressure in the anal canal moves cranially in relation to the anterior peak pressure, with squeeze. Similar to the movement of peak posterior pressure, MR images show cranial movement of anorectal angle with squeeze. Our study proves that the PRM is responsible for the closure of the cranial part of anal canal. HDAM, in addition to measuring constrictor function can also record the elevator function of levator ani/pelvic floor muscles. © 2011 Blackwell Publishing Ltd.

  15. The performance of anal cytology as a screening test for anal HSILs in homosexual men.

    PubMed

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

    2016-06-01

    Studies regarding the performance of anal cytology in which both the screening test (cytology) and the diagnostic test (high-resolution anoscopy [HRA]) are performed in all members of a screening population are rare. The authors evaluated the performance of liquid-based anal cytology in a cohort of homosexual men in Sydney, New South Wales, Australia. The Study of the Prevention of Anal Cancer (SPANC) is a 3-year prospective study of the natural history of anal human papillomavirus infection in homosexual men aged ≥35 years. At baseline, all participants underwent a liquid-based anal cytology test and HRA at the same clinical visit. Biopsies were obtained for histological assessment if lesions suspicious for human papillomavirus infection were visible during HRA. Using any cytological abnormality as the threshold, the sensitivity, specificity, and positive and negative predictive values were calculated against histologically diagnosed high-grade squamous intraepithelial lesions (HSILs). Among 617 men recruited, the median age was 49 years (range, 35-79 years) and 35.7% were positive for the human immunodeficiency virus. Overall, the sensitivity of cytology was 83.2%, the specificity was 52.6%, the positive predictive value was 45.8%, and the negative predictive value was 86.7%. Specificity improved with increasing age (P for trend =.041). Sensitivity was significantly higher in men with >1 anal octant of biopsy-confirmed HSIL (92.9% vs 77.7%; P = .010), and in those who had ≥10 metaplastic cells present on their cytology slides (87.5% vs 70.2%; P = .007). Anal cytology was found to have a higher specificity in older men while maintaining sensitivity. Sensitivity was higher among those with more extensive HSILs and men with metaplastic cells present on cytology. Cancer Cytopathol 2016;124:415-24. © 2016 American Cancer Society. © 2016 American Cancer Society.

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

    PubMed

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

    2017-06-01

    To evaluate prevalence and risk factors for long-term anal incontinence in women with two prior vaginal deliveries without obstetric anal sphincter injury (OASIS) and to assess the impact of anal incontinence-related symptoms on quality of life. This is a nation-wide cross-sectional survey study. One thousand women who had a first vaginal delivery and a subsequent delivery, both without OASIS, between 1997 and 2008 in Denmark were identified in the Danish Medical Birth Registry. Women with more than two deliveries in total till 2012 were excluded at this stage. Of the 1000 women randomly identified, 763 were eligible and received a questionnaire. Maternal and obstetric data were retrieved from the national registry. The response rate was 58.3%. In total, 394 women were included for analysis after reviewing responses according to previously defined exclusion criteria. Median follow-up time was 9.8 years after the first delivery and 6.4 years after the second. The prevalence of flatal incontinence, fecal incontinence and fecal urgency were 11.7, 4.1, and 12.3%, respectively. Overall, 20.1% had any degree of anal incontinence and/or fecal urgency. In 6.3% these symptoms affected their quality of life. No maternal or obstetric factors including episiotomy and vacuum extraction were consistently associated with altered risk of anal incontinence in the multivariable analyses. Anal incontinence and fecal urgency is reported by one fifth of women with two vaginal deliveries without OASIS at long-term follow-up. Episiotomy or vacuum extraction did not alter the risk of long-term anal incontinence.

  17. 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

  18. Internal anal sphincter augmentation and substitution

    PubMed Central

    de la Portilla, Fernando

    2014-01-01

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

  19. 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. Copyright © 2014. Published by Elsevier Masson SAS.

  20. Remineralization Capacity of Three Fissure Sealants with and without Gaseous Ozone on Non-Cavitated Incipient Pit and Fissure Caries.

    PubMed

    Unal, M; Oztas, N

    2015-01-01

    The purpose of this study was to investigate the remineralization activation of the application of three fissure sealants (FSs), alone or with gaseous ozone (GO), on non-cavitated initial caries and evaluate the clinical success of FS. Sixty children who had DIAGNOdent scores between 10-30 on bilateral symmetric mandibular first permanent molars were included in study. In a split-mouth design, teeth were assigned to experimental (with GO) and control (without GO) groups. GO was applied to teeth on one side and then the same brand of randomly selected FSs was applied to the teeth on both sides. Children were divided into 3 groups based on type of FS (Group 1: Aegis {Bosworth Co, North Hamlin Avenue Skokie, Illinois, USA}, Group 2: Fuji Triage {GC, Tokyo, Japan}, Group 3: Helioseal {Ivoclar Vivadent, Liechtenstein, Germany}). All FSs were then examined for retention rates at 1, 3, 6, 9, and 12 months; at the end of 12 months, all FSs were removed with an air-abrasion device and DIAGNOdent scores noted to compare with the initial values. The application of GO with either Fuji Triage or Aegis FS was effective on remineralization (p<0.05); however, the application of Helioseal FSs was not effective (p>0.05). The 1(st) and 12(th) months' full retention rates of Fuji Triage FSs was a significant difference (p<0.05) from other FSs (Aegis and Helioseal) (p>0.05). GO+Aegis FS showed the highest remineralization; and, at the end of 12 months, its clinical success was higher than other FSs.

  1. Geometry of the September 1971 eruptive fissure at Kilauea volcano, Hawaii

    USGS Publications Warehouse

    Dvorak, J.J.

    1990-01-01

    A three-dimensional model has been used to estimate the location and dimensions of the eruptive fissure for the 24-29 September 1971 eruption along the southwest rift zone of Kilauea volcano, Hawaii. The model is an inclined rectangular sheet embedded in an elastic half-space with constant displacement on the plane of the sheet. The set of "best" model parameters suggests that the sheet is vertical, extends from a depth of about 2 km to the surface, and has a length of about 14 km. Because this sheet intersects the surface where eruptive vents and extensive ground cracking formed during the eruption, this sheet probably represents the conduit for erupted lava. The amount of displacement perpendicular to the sheet is about 1.9 m, in the middle range of values measured for the amount of opening across the September 1971 eruptive fissure. The thickness of the eruptive fissure associated with the January 1983 east rift zone eruption was determined in an earlier paper to be 3.6 m, about twice the thickness determined here for the September 1971 eruption. Because the lengths (12 km for 1983 and 14 km for 1971) and heights (about 2 km) of the sheet models derived for the January 1983 and September 1971 rift zone eruptions are nearly identical, the greater thickness for the January 1983 eruptive fissure implies that the magma pressure was about a factor of two greater to form the January 1983 eruptive fissure. Because the September 1971 and January 1983 eruptive fissures extent to depths of only a few kilometers, the region of greatest compressive stress produced along the volcano's flank by either of these eruptive fissures would also be within a few kilometers of the surface. Previous work has shown that rift eruptions and intrusions contribute to the buildup of compressive stress along Kilauea's south flank and that this buildup is released by increased seismicity along the south flank. Because south flank earthquakes occur at significantly greater depths, i.e., from 5

  2. Geometry of the September 1971 eruptive fissure at Kilauea volcano, Hawaii

    NASA Astrophysics Data System (ADS)

    Dvorak, John J.

    1990-09-01

    A three-dimensional model has been used to estimate the location and dimensions of the eruptive fissure for the 24 29 September 1971 eruption along the southwest rift zone of Kilauea volcano, Hawaii. The model is an inclined rectangular sheet embedded in an elastic half-space with constant displacement on the plane of the sheet. The set of “best” model parameters suggests that the sheet is vertical, extends from a depth of about 2 km to the surface, and has a length of about 14 km. Because this sheet intersects the surface where eruptive vents and extensive ground cracking formed during the eruption, this sheet probably represents the conduit for erupted lava. The amount of displacement perpendicular to the sheet is about 1.9 m, in the middle range of values measured for the amount of opening across the September 1971 eruptive fissure. The thickness of the eruptive fissure associated with the January 1983 east rift zone eruption was determined in an earlier paper to be 3.6 m, about twice the thickness determined here for the September 1971 eruption. Because the lengths (12 km for 1983 and 14 km for 1971) and heights (about 2 km) of the sheet models derived for the January 1983 and September 1971 rift zone eruptions are nearly identical, the greater thickness for the January 1983 eruptive fissure implies that the magma pressure was about a factor of two greater to form the January 1983 eruptive fissure. Because the September 1971 and January 1983 eruptive fissures extent to depths of only a few kilometers, the region of greatest compressive stress produced along the volcano's flank by either of these eruptive fissures would also be within a few kilometers of the surface. Previous work has shown that rift eruptions and intrusions contribute to the buildup of compressive stress along Kilauea's south flank and that this buildup is released by increased seismicity along the south flank. Because south flank earthquakes occur at significantly greater depths, i

  3. A One-Year Evaluation of a Free Fissure Sealant Program

    PubMed Central

    M, Bakhtiar; N, Azadi; A, Golkari

    2016-01-01

    Statement of Problem: Pit and fissure sealant therapy has been approved as an effective measure in the prevention of occlusal dental caries. Resin based materials are the most common materials used worldwide. A variety of resin based fissure sealants are produced and used. Most of them have been presented with ideal results in research environment. However, their effectiveness in the real life, especially in a mass application program such as Iran’s oral health reform plan is not clear. Objectives: To evaluate the longevity of different fissure sealant applied in Iran’s oral health reform plan in Fars Province (south of Iran) after one year. Materials and Methods: Seven counties were selected. One hundred 6- to 8-year-old school children who had undergone fissure sealant therapy in spring 2015 were randomly selected from each county. Their first molars were examined to evaluate the status of the fissure sealants which were applied one year ago. Data on the type/brand of fissure sealant materials, type and experience of clinicians who applied them, existence of a chair-side assistant, and whether the children were caries-free at the time of fissure sealant application were collected from the existing reports. Results: Data of 1974 teeth from 598 children were used for the final analysis. The effects of type/brand of the material was significant on the final results and remained significant (p < 0.001) after adjustments for the level of fluoride, urban/rural area, upper/lower jaw, type of clinician who applied the sealant, existence of a chair-side assistant, and child’s gender, age, and being caries-free. Conclusions: Many factors affect the success rate of a fissure sealant therapy program. The type/brand of the material remained significantly related to the success rate of the fissure sealant even after adjustments for other influencing factors. In this study, ClinproTM Sealant (3M/ESPE, USA) showed better longevity after one year of application. PMID

  4. Natural progression of anal incontinence after childbirth.

    PubMed

    Nordenstam, Johan; Altman, Daniel; Brismar, Sophia; Zetterström, Jan

    2009-09-01

    The aim of work is to study the natural progression of anal incontinence (AI) in women 10 years after their first delivery and to identify risk factors associated with persistent AI. A prospective cohort study of 304 primiparous women with singleton, cephalic delivery giving vaginal childbirth in 1995. Questionnaires distributed and collected at delivery, 9 months, 5 years and 10 years after, assessing anorectal symptoms, subsequent treatment, and obstetrical events. Women, 246 of 304, answered all questionnaires (81%). Thirty-five of 246 (14%) had a sphincter tear at the first delivery. One hundred ninety-six of 246 (80%) women had additional vaginal deliveries and no caesarean sections. The prevalence of AI at 10 years after the first delivery was 57% in women with a sphincter tear and 28% in women, a nonsignificant increase compared to the 5-year follow-up. Women who sustained a sphincter tear at the first delivery had an increased risk of severe AI (RR 3.9, 95% CI 1.3-11.8). Neither age, nor subsequent deliveries added to the risk. Severe AI at baseline and 5 years after delivery were independently strong predictors of severe AI at 10 years (RR 12.6, CI 3.3-48.3, and RR 8.3, CI 3.9-17.8, respectively). Persistent anal incontinence 10 years after the first parturition is frequent and sometimes severe, especially if vaginal delivery was complicated by an anal sphincter disruption.

  5. 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.

  6. Proctology - diseases of the anal region.

    PubMed

    Kreuter, Alexander

    2016-04-01

    Proctology is a medical subspecialty that encompasses diseases of the perianal region, anal canal, and rectum. Dermatologists play a pivotal role in this realm, as inflammatory perianal disorders, infectious and sexually transmitted diseases, as well as perianal tumors and their precursor lesions fall within the core competency of dermatology. In a concise manner, the present article highlights all relevant disease groups in the field of proctology. With a particular focus on aspects pertinent to dermatologists, this includes inflammatory disorders, "classic" proctologic diseases, sexually transmitted diseases, malignancies of the anal region, as well as pathogen-induced diseases. Despite the wide variety of disorders, there are only five key symptoms prompting patients to consult a proctologist, including anal pruritus and burning, discharge, bleeding, pain, and foreign body sensation. A simple algorithm, which incorporates these symptoms as well as key clinical features, may assist in quickly establishing the correct diagnosis in everyday clinical practice. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  7. In vitro evaluation of shear bond strength and microleakage of different pit and fissure sealants

    PubMed Central

    Babaji, Prashant; Vaid, Shivali; Deep, S.; Mishra, Samvit; Srivastava, Madhulika; Manjooran, Thomas

    2016-01-01

    Aim and Objectives: Fissure caries is most common in children due to deep pit and fissures. Pit and fissure areas on the occlusal surface of the teeth make them susceptible to dental caries, which need to be prevented or restored. Fissures sealant reduces the risk of occlusal caries. The present study was done to evaluate microleakage and shear bond strength of various fissure sealants. Materials and Methods: Thirty-six extracted molars were randomly allocated equally (n = 12) into three groups with three different sealants to evaluate shear bond strength and microleakage at sealant space. The shear bond strengths was evaluated with one-way analysis of variance and microleakage by Kruskal-Wallis nonparametric test using the Statistical Package for the Social Sciences version 18.0 (Chicago: SPSS Inc, 2009). Results: Tetric flow (16.8 MPa) recorded the highest shear bond strength and the difference was statistically significant with enamel loc (12.8 MPa). There was no statistically significant difference in relation to microleakage (P > 0.05) in the tested groups. Conclusions: Tetric flow recorded the highest shear bond strength and the difference was statistically significant with enamel loc. However, there was no statistically significant difference among the groups regarding microleakage. PMID:27652241

  8. Effect of ozone pretreatment on the microleakage of pit and fissure sealants.

    PubMed

    Cehreli, S Burcak; Yalcinkaya, Zeynep; Guven-Polat, Gunseli; Cehreli, Zafer Cavit

    2010-01-01

    This study investigated the effect of ozone pretreatment on the microleakage and marginal integrity of pit and fissure sealants placed with or without a self-etch 6th generation adhesive. Freshly-extracted, human third molars were randomly assigned into two main groups (n = 48): Group A: Fissures were pretreated with ozone; Group B: Fissures were left untreated. The teeth were further randomly divided into two subgroups (n = 24/each) so that half of teeth were sealed with a conventional fissure sealant (Fissurit F, Voco, Germany), while the remaining half received the same sealant bonded with a self-etch adhesive (Clearfil Protect Bond, Kuraray, Japan). Following thermal cycling (1000X), the specimens were subjected to dye penetration within 0.5% basic fuchsin for 24h. The extent of dye penetration was measured by image analysis. Kruskal Wallis and Mann-Whitney U tests were used for statistical analysis of the data (p = 0.05). Two randomly-selected sections from each group were observed under SEM RESULTS: In all groups, ozone pretreatment significantly reduced the extent of microleakage (p < 0.001). SEM investigation demonstrated better adaptation of the sealants in ozone-pretreated groups. Clearfil Protect Bond did not improve the marginal seal of Fissurit F (p > 0.05). Ozone pretreatment favorably affected the marginal sealing ability of the tested fissure sealants.

  9. Maps showing water-level declines, land subsidence, and earth fissures in south-central Arizona

    USGS Publications Warehouse

    Laney, R.L.; Raymond, R.H.; Winikka, C.C.

    1978-01-01

    From 1915 to 1975, more than 109 million acre-feet of ground water was withdrawn from about 4,500 square miles in Pinal and Maricopa Counties in south-central Arizona. The volume of water withdrawn greatly exceeds the volume of natural recharge, and water levels have been declining since 1923. As a result of the water-level declines, the land surface has subsided, the alluvial deposits have been subjected to stress, and earth fissures have developed. Land subsidence and earth fissures have damaged public and private properties. Subsidence and fissures will continue to occur as long as ground water is being mined and water levels continue to decline. As urban development expands, land subsidence and earth fissures will have an increasing socioeconomic impact. Information on maps includes change in water levels, measurements of land subsidence, and location of earth fissures. A section showing land subsidence between Casa Grande and the Picacho Peak Interchange also is included. Scale 1:250,000. (Woodard-USGS)

  10. The role of anal ultrasound in the management of anal fistulas.

    PubMed

    Lindsey, I; Humphreys, M. M; George, B. D; Mortensen, N. J. M. C

    2002-03-01

    OBJECTIVE: To assess the accuracy of anal ultrasound (AUS) for anal fistulas, and the impact of routine pre-operative AUS on their surgical management. METHODS: Pre-operative AUS was performed in 38 consecutive patients with an anal fistula using a 10-MHz Brüel & Kjaer probe. All patients underwent subsequent examination under anaesthetic (EUA) with documentation of the anatomy of the fistula before the surgeon was shown the AUS results. Agreement between AUS and EUA findings and any modification to the surgical treatment was recorded. RESULTS: There was 84% agreement between AUS and EUA findings regarding presence and site of fistulas. One fistula not seen at AUS was found at EUA, and 5 fistulas seen on AUS were not demonstrated at EUA. AUS influenced the surgery undertaken in 9/24 (38%) patients; demonstrating occult sphincter defects (2 patients), reclassifying fistulas from low to higher fistulas (3 patients), deciding a surgical treatment open to doubt (2 patients) and helping identify an obscure fistula not initially found at EUA (2 patients). CONCLUSIONS: Accuracy of AUS in the assessment of anal fistulas is confirmed. Operative management is influenced in 38% of cases, usually towards more conservative treatment. We recommend the use of pre-operative AUS in the assessment of anal fistulas.

  11. 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

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

    PubMed Central

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

    2015-01-01

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

  13. Thermal control of shape memory alloy artificial anal sphincters for complete implantation

    NASA Astrophysics Data System (ADS)

    Luo, Yun; Okuyama, Takeshi; Takagi, Toshiyuki; Kamiyama, Takamichi; Nishi, Kotaro; Yambe, Tomoyuki

    2005-02-01

    This paper presents an approach for the thermal control of an artificial anal sphincter using shape memory alloys. An artificial anal sphincter has been proposed by the authors to resolve problems of severe fecal incontinence in patients. The basic design of the artificial sphincter consists of two all-round shape memory alloy plates as the main functional parts, and heaters that are attached to the SMA plates for generating the thermal cycles required for the phase transformation accompanied shape changes of the plates. The SMA artificial sphincter could be fitted around intestines, performing an occlusion function at body temperature and a release function upon heating. Thermal compatibility of such prostheses is most important and is critical for practical use. Since a temperature rise of approximately 20 °C from body temperature is needed to activate a complete transformation of SMA plates, an earlier model of ours allowed only a short period of heating, resulting in incomplete evacuation. In this work, a thermal control approach using a temperature-responsive reed switch has been incorporated into the device to prevent the SMA plates from overheating. Then, with thermal insulation the artificial anal sphincter is expected to allow a long enough opening period for fecal continence; without any thermal impact to the surrounding tissues that would be in contact with the artificial sphincter. Thermal control was confirmed in both in vitro and in vivo experiments, suggesting the effectiveness of the present approach. The modified SMA artificial anal sphincter has been implanted into animal models for chronic experiments of up to 4 weeks, and has exhibited good performance by maintaining occlusion and release functions. At autopsy, no anomaly due to thermal impact was found on the surfaces of intestines that had been in contact with the artificial anal sphincter.

  14. Gay and Bisexual Men's Willingness to Receive Anal Papanicolaou Testing

    PubMed Central

    Reed, Alison C.; Reiter, Paul L.; Smith, Jennifer S.; Palefsky, Joel M.

    2010-01-01

    Objectives. We assessed the willingness of gay and bisexual men, who have high rates of anal cancer that might be prevented through regular screening, to receive anal Papanicolaou tests. Methods. We surveyed a national sample of men aged 18 to 59 years who self-identified as gay (n = 236) or bisexual (n = 70). Results. Most respondents were willing to accept free screening (83%), but fewer would pay for the test (31%; McNemar's χ2 = 158.02; P < .001). Willingness to pay for screening was higher among men who reported greater worry about getting anal cancer (OR [odds ratio] = 1.70; 95% confidence interval [CI] = 1.06, 2.72), higher perceived likelihood of anal cancer (OR = 1.88; 95% CI = 1.18, 2.99), and higher income (OR = 2.17; 95% CI = 1.18, 3.98), in adjusted analyses. Only 33% (17 of 51) of HIV-positive respondents, who have the highest risk for anal cancer, had received anal Papanicolaou tests. Conclusions. Anal cancer screening was highly acceptable to gay and bisexual men, although cost was a major barrier. Efforts to reduce anal cancer disparities should target beliefs about anal cancer and barriers to anal Papanicolaou testing in this population. PMID:20395576

  15. An experimental study on fracture mechanical behavior of rock-like materials containing two unparallel fissures under uniaxial compression

    NASA Astrophysics Data System (ADS)

    Huang, Yan-Hua; Yang, Sheng-Qi; Tian, Wen-Ling; Zeng, Wei; Yu, Li-Yuan

    2016-06-01

    Strength and deformability characteristics of rock with pre-existing fissures are governed by cracking behavior. To further research the effects of pre-existing fissures on the mechanical properties and crack coalescence process, a series of uniaxial compression tests were carried out for rock-like material with two unparallel fissures. In the present study, cement, quartz sand, and water were used to fabricate a kind of brittle rock-like material cylindrical model specimen. The mechanical properties of rock-like material specimen used in this research were all in good agreement with the brittle rock materials. Two unparallel fissures (a horizontal fissure and an inclined fissure) were created by inserting steel during molding the model specimen. Then all the pre-fissured rock-like specimens were tested under uniaxial compression by a rock mechanics servo-controlled testing system. The peak strength and Young's modulus of pre-fissured specimen all first decreased and then increased when the fissure angle increased from 0° to 75°. In order to investigate the crack initiation, propagation and coalescence process, photographic monitoring was adopted to capture images during the entire deformation process. Moreover, acoustic emission (AE) monitoring technique was also used to obtain the AE evolution characteristic of pre-fissured specimen. The relationship between axial stress, AE events, and the crack coalescence process was set up: when a new crack was initiated or a crack coalescence occurred, the corresponding axial stress dropped in the axial stress-time curve and a big AE event could be observed simultaneously. Finally, the mechanism of crack propagation under microscopic observation was discussed. These experimental results are expected to increase the understanding of the strength failure behavior and the cracking mechanism of rock containing unparallel fissures.

  16. Clinical Evaluation of the Retention of Different Pit and Fissure Sealants: A 1-Year Study

    PubMed Central

    Kumaran, Parvathy

    2013-01-01

    ABSTRACT Objective: The aim of this study was to evaluate the retention of different pit and fissure sealants on the first permanent molars over a period of one year. Materials and methods: In this study, a total of 40 children with all first permanent molars erupted received four different pit and fissure sealants. The children were evaluated at 6 and 12 months. Results: The data was subjected to Chi-square test and Kaplan Meier survival analysis. The p-value was calculated using Wilcoxon matched-pairs signed-rank test. Conclusion: The retention rates of resin-based sealants were superior to that of glass ionomer sealant. How to cite this article: Kumaran P. Clinical Evaluation of the Retention of Different Pit and Fissure Sealants: A 1-Year Study. Int J Clin Pediatr Dent 2013;6(3):183-187. PMID:25206219

  17. The economics of pit and fissure sealants in preventive dentistry: a review.

    PubMed

    Kitchens, Dinah H

    2005-08-15

    Oral diseases are progressive, cumulative, and become more intricate to treat with advancement. While dental caries is an infectious transmissible disease with children being at the highest risk, primary prevention can reduce this risk. Primary prevention in dentistry is usually considered to be community fluoridated water supplies, professional fluoride treatments, and pit and fissure sealants. While community fluoridated water supplies have been proven to be cost-effective, the cost-effectiveness of pit and fissure sealants has primarily been studied in school-based programs of children from low socio-economic backgrounds. Dental sealant programs are just one way to help increase primary prevention in the oral health disparities of children. The purpose of this paper is to review the literature regarding the cost-effectiveness of pit and fissure sealants as a preventive strategy in preventive dentistry.

  18. Bond strength and microleakage of self-adhesive and conventional fissure sealants.

    PubMed

    Simsek Derelioglu, Sera; Yilmaz, Yucel; Celik, Pelin; Carikcioglu, Burak; Keles, Sultan

    2014-01-01

    The aim of this study was to compare the shear bond strengths (SBS), failure modes (adhesive, cohesive, or mixed), and marginal microleakage occurrence of conventional resin (CR)-based, glass ionomer (GI)-based, and self-adhesive resin (SAR)-based fissure sealants with or without prior phosphoric acid (PA) etching. Fifty extracted premolars were randomly and equally assigned into five groups -G1:PA+CR, G2:PA+GI, G3:GI, G4:PA+SAR, and G5:SAR. Prior PA etching significantly (p<0.05) increased the SBSs of sealants. Adhesive failure mainly occurred in teeth treated with SAR- or GI-based fissure sealants, and cohesive failure mainly occurred in PA-etched teeth. Microleakage occurrence differed significantly (p<0.05) among the five groups of treated teeth. We concluded that conditioning of a tooth's enamel surface is crucial to creating strong bonds and leak-free sealing between tooth and fissure sealant.

  19. Femtosecond Laser in situ Keratomileusis Flap Creation in Narrow Palpebral Fissure Eyes without Suction.

    PubMed

    Chang, John S M; Law, Antony K P; Ng, Jack C M; Cheng, May S Y

    2017-01-01

    To evaluate a surgical technique used in eyes with narrow palpebral fissure undergoing femtosecond laser flap creation without suction during laser in situ keratomileusis (LASIK). All data of 2 patient groups were collected through chart review. Group 1 consisted of 6 eyes with narrow palpebral fissure in which the suction ring was manually fixated and femtosecond laser was applied accordingly. Thirty comparison cases were randomly drawn from among eyes that underwent a standard LASIK procedure matched for age and preoperative refraction (group 2). Only 1 eye of each patient was selected to compare the refractive and visual outcomes between groups. In all group 1 eyes, the flaps were created successfully with manual fixation of the suction ring without suction. No eyes lost 2 or more lines of vision. No significant difference was found in the safety and refractive outcomes between groups. Manual fixation of the suction ring in eyes with narrow palpebral fissure without suction was feasible for flap creation during LASIK.

  20. 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

  1. A robotic approach to mapping post-eruptive volcanic fissure conduits

    NASA Astrophysics Data System (ADS)

    Parcheta, Carolyn E.; Pavlov, Catherine A.; Wiltsie, Nicholas; Carpenter, Kalind C.; Nash, Jeremy; Parness, Aaron; Mitchell, Karl L.

    2016-06-01

    VolcanoBot was developed to map volcanic vents and their underlying conduit systems, which are rarely preserved and generally inaccessible to human exploration. It uses a PrimeSense Carmine 1.09 sensor for mapping and carries an IR temperature sensor, analog distance sensor, and an inertial measurement unit (IMU) inside a protective shell. The first field test succeeded in collecting valuable scientific data but revealed several needed improvements, including more rugged cable connections and mechanical couplers, increased ground clearance, and higher-torque motors for uphill mobility. The second field test significantly improved on all of these aspects but it traded electrical ruggedness for reduced data collection speed. Data collected by the VolcanoBots, while intermittent, yield the first insights into the cm-scale geometry of volcanic fissures at depths of up to 25 m. VolcanoBot was deployed at the 1969 Mauna Ulu fissure system on Kīlauea volcano in Hawai'i. It collected first-of-its-kind data from inside the fissure system. We hypothesized that 1) fissure sinuosity should decrease with depth, 2) irregularity should be persistent with depth, 3) any blockages in the conduit should occur at the narrowest points, and 4) the fissure should narrow with depth until it is too narrow for VolcanoBot to pass or is plugged with solidified lava. Our field campaigns did not span enough lateral or vertical area to test sinuosity. The preliminary data indicate that 1) there were many irregularities along fissures at depth, 2) blockages occurred, but not at obviously narrow locations, and 3) the conduit width remained a consistent 0.4-0.5 m for most of the upper 10 m that we analyzed.

  2. The effect of CT technical factors on quantification of lung fissure integrity

    NASA Astrophysics Data System (ADS)

    Chong, D.; Brown, M. S.; Ochs, R.; Abtin, F.; Brown, M.; Ordookhani, A.; Shaw, G.; Kim, H. J.; Gjertson, D.; Goldin, J. G.

    2009-02-01

    A new emphysema treatment uses endobronchial valves to perform lobar volume reduction. The degree of fissure completeness may predict treatment efficacy. This study investigated the behavior of a semiautomated algorithm for quantifying lung fissure integrity in CT with respect to reconstruction kernel and dose. Raw CT data was obtained for six asymptomatic patients from a high-risk population for lung cancer. The patients were scanned on either a Siemens Sensation 16 or 64, using a low-dose protocol of 120 kVp, 25 mAs. Images were reconstructed using kernels ranging from smooth to sharp (B10f, B30f, B50f, B70f). Research software was used to simulate an even lower-dose acquisition of 15 mAs, and images were generated at the same kernels resulting in 8 series per patient. The left major fissure was manually contoured axially at regular intervals, yielding 37 contours across all patients. These contours were read into an image analysis and pattern classification system which computed a Fissure Integrity Score (FIS) for each kernel and dose. FIS values were analyzed using a mixed-effects model with kernel and dose as fixed effects and patient as random effect to test for difference due to kernel and dose. Analysis revealed no difference in FIS between the smooth kernels (B10f, B30f) nor between sharp kernels (B50f, B70f), but there was a significant difference between the sharp and smooth groups (p = 0.020). There was no significant difference in FIS between the two low-dose reconstructions (p = 0.882). Using a cutoff of 90%, the number of incomplete fissures increased from 5 to 10 when the imaging protocol changed from B50f to B30f. Reconstruction kernel has a significant effect on quantification of fissure integrity in CT. This has potential implications when selecting patients for endobronchial valve therapy.

  3. Groundwater circulation between volcanic fissure systems evidenced by water stable isotopes

    NASA Astrophysics Data System (ADS)

    Sveinbjornsdottir, Arny

    2016-04-01

    The divergent boundary between the European and American plates in Iceland, generally called the Neovolcanic zone, is characterized by well defined volcanic systems, each consisting of a central volcano, fissure swarm and a high temperature hydrothermal activity. Isotopic studies within the Northern part of the Neovolcanic zone, where five NNE striking left-stepping en echelon volcanic systems have been identified indicate both a very complex groundwater inflow and geological structure of the thermal areas. The isotopic values of the thermal waters vary considerably both within and between systems. The fluids are a mixture of precipitation, either local or from far away, and older groundwater with a pre-Holocene component. Observed oxygen shift is highly variable from less than 1‰ to about 7‰. On surface the volcanic systems and fissure swarms are very distinct and well separated. Groundwater flow is mainly fissure/fracture controlled and thus assumed to be only along the fissure swarms with little or no flow connection between the volcanic systems. However recent isotopic studies have shown some evidence that at depth the thermal water can flow from one volcanic fissure system to the next. This is in accordance with recent observations of a segmented dyke intrusion in one of the volcanic system (Bárdarbunga) that grew laterally for more than 45 km at a relatively shallow depth (5-8 km) and ended in an effusive fissure eruption within the nearby Askja volcanic system (Sigmundsson et al., 2015). Isotopic data on the thermal waters within the Northern part of the Neovolcanic zone will be presented and fluid circulation within the volcanic systems constructed.

  4. Conversion degree, microhardness, microleakage and fluoride release of different fissure sealants.

    PubMed

    Kuşgöz, Adem; Tüzüner, Tamer; Ulker, Mustafa; Kemer, Bariş; Saray, Onur

    2010-11-01

    The purpose of this study was to determine the degree of conversion (DC), microhardness, microleakage and fluoride release of a nano-filled resin based fissure sealant (Grandio Seal, GS) and compare it with an un-filled resin based fissure sealant (Clinpro, CL) and a glass-ionomer based fissure sealant (Fuji Triage, FT). Disk shaped specimens were prepared from tested fissure sealants to determine the DC, Vicker hardness (VHN) and fluoride release (FR). The DC and VHN of each material was evaluated after 24 h. The cumulative fluoride concentrations were evaluated at 1 h, 6 h, 12 h, 1, 7, 15 and 30 days. For microleakage evaluation, fissure sealants were applied to the etched and dried enamel surfaces of sound third molar teeth according to the manufacturer's instructions (n=10). After the thermocycling and mechanical loading procedures, microleakage assessments were carried out. Data were analyzed using one-way ANOVA followed by a post hoc Tukey test, the Kruskal Wallis and Mann-Whitney U test (p<0.05). Results revealed differences regarding DC between all groups: FT (89%) > GS (55.02%) > CL (%51.10) (p<0.05). The VHN values were significantly different among all groups in the following order: GS > FT > CL (p<0.05). FT exhibited significantly higher microleakage scores compared to the CL and GS sealants (p<0.05). The FR of FT was significantly greater than CL and GS (p<0.05). Nano-filled resin based sealant can be used as an alternative to other fissure sealant materials because of its superior hardness results and feasible sealing ability.

  5. Clinical and gross pathologic findings of complicated vertical fissures with digital dermatitis in a dairy herd.

    PubMed

    Nouri, Mohsen; Ashrafi Helan, Javad

    2012-01-01

    Careful antemortem examination and interpretation of findings, assisted by good clinical records, do much to throw light on the nature of vertical fissure in cattle. During an eight month period of investigation, 13 (3.2%) lame cows with vertical fissure out of 52 Holstein cows with different claw fissures were selected for clinical and gross pathological purposes in a commercial dairy farm with 400 milking cows in Nazarabad, Iran. The cows were 2.5 to10.5 years old. The prevalence rate of vertical fissure was 3.2 per cent. The prevalence rate of claw lesion in the hind limb (69.2%) was higher than that of fore limb (30.7%). The type of vertical fissures were 4 (38.4%), 5 (23.0%), 2 (23.0%) and 3 (15.3%), respectively. Locomotion scoring assessment of 13 culled lame cows showed score ranged from grade 3 (30.7%) to 4 (61.5%). The herd had endemic digital dermatitis infection with prevalence in the adult herd of over 34.2%. The affected claws were more boxy than normal and the abaxial wall was convex in all directions. The lame cows had typical stance such as hobbyhorse or cross legged stance. This study shows that more research is needed both on the economic impact of vertical fissures in dairy cows and on the microbiological study of spirochaetes of the genus Treponema. This study recommends that owners of dairy farm should try to control digital dermatitis with preventative herd strategies.

  6. Cyp1b1 Regulates Ocular Fissure Closure Through a Retinoic Acid–Independent Pathway

    PubMed Central

    Williams, Antionette L.; Eason, Jessica; Chawla, Bahaar; Bohnsack, Brenda L.

    2017-01-01

    Purpose Mutations in the CYP1B1 gene are the most commonly identified genetic causes of primary infantile-onset glaucoma. Despite this disease association, the role of CYP1B1 in eye development and its in vivo substrate remain unknown. In the present study, we used zebrafish to elucidate the mechanism by which cyp1b1 regulates eye development. Methods Zebrafish eye and neural crest development were analyzed using live imaging of transgenic zebrafish embryos, in situ hybridization, immunostaining, TUNEL assay, and methylacrylate sections. Cyp1b1 and retinoic acid (RA) levels were genetically (morpholino oligonucleotide antisense and mRNA) and pharmacologically manipulated to examine gene function. Results Using zebrafish, we observed that cyp1b1 was expressed in a specific spatiotemporal pattern in the ocular fissures of the developing zebrafish retina and regulated fissure patency. Decreased Cyp1b1 resulted in the premature breakdown of laminin in the ventral fissure and altered subsequent neural crest migration into the anterior segment. In contrast, cyp1b1 overexpression inhibited cell survival in the ventral ocular fissure and prevented fissure closure via an RA-independent pathway. Cyp1b1 overexpression also inhibited the ocular expression of vsx2, pax6a, and pax6b and increased the extraocular expression of shha. Importantly, embryos injected with human wild-type but not mutant CYP1B1 mRNA also showed colobomas, demonstrating the evolutionary and functional conservation of gene function between species. Conclusions Cyp1b1 regulation of ocular fissure closure indirectly affects neural crest migration and development through an RA-independent pathway. These studies provide insight into the role of Cyp1b1 in eye development and further elucidate the pathogenesis of primary infantile-onset glaucoma. PMID:28192799

  7. Risk factors for anal HPV infection and anal precancer in HIV-infected men who have sex with men.

    PubMed

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

    2013-12-01

    Carcinogenic human papillomaviruses (HPVs) cause a large proportion of anal cancers. Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at increased risk of HPV infection and anal cancer compared with HIV-negative men. We evaluated risk factors for HPV infection and anal precancer in a population of HIV-infected MSM. Our study included 305 MSM at an HIV/AIDS clinic in the Kaiser Permanente Northern California Health Maintenance Organization. Logistic regression was used to estimate associations of risk factors comparing men without anal HPV infection; men with anal HPV infection, but no precancer; and men with anal precancer. Low CD4 count (<350 cells/mm(3)) and previous chlamydia infection were associated with an increased risk of carcinogenic HPV infection (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.28-10.40 and OR, 4.24; 95% CI, 1.16-15.51, respectively). History of smoking (OR, 2.71 95% CI, 1.43-5.14), duration, recency, and dose of smoking increased the risk of anal precancer among carcinogenic HPV-positive men but had no association with HPV infection. We found distinct risk factors for anal HPV infection and anal precancer. Risk factors for HPV infection and anal precancer are similar to established risk factors for cervical cancer progression.

  8. Caries detection and diagnosis, sealants and management of the possibly carious fissure.

    PubMed

    Deery, C

    2013-06-01

    The diagnosis and management of 'stained' or possibly carious pits and fissures is a difficult clinical problem. Historically, clinicians have restoratively intervened at an early stage because of concern that caries will progress unless completely removed and a restoration placed. However, this approach is destructive of tooth tissue and in the longer term may compromise the tooth as it enters the restoration re-restoration cycle. This paper aims to update the reader on developments in sealant technology and the use of sealants in caries prevention and management with an emphasis on the options available to manage the questionable fissure.

  9. Marked congenital fissure masquerading as splenic laceration: report of a case

    SciTech Connect

    Hansen, R.M.; Spiegelhoff, D.R.

    1981-02-01

    A 26-year-old white woman fell from a ladder striking her back. Clinical evaluation indicated a left renal contusion with microscopic hematuria, and a liver-spleen scan suggested a splenic laceration. The patient was initially stable but evidence of ongoing blood loss forced exploratory laparotomy on the third hospital day. A large, retroperitoneal perirenal hematoma was found but the spleen was intact, with multiple marked congenital fissures. The problem of congenital fissures as a cause of abnormal spleen scan is discussed.

  10. The Human Papillomavirus Vaccine: Current Perspective and Future Role in Prevention and Treatment of Anal Intraepithelial Neoplasia and Anal Cancer

    PubMed Central

    Mehta, Mudresh R.; Lewis, James S.; Lockhart, A. Craig

    2016-01-01

    The incidences of human papillomavirus (HPV)-related anal cancer and its precursor lesion, anal intraepithelial neoplasia, are rising in the U.S. and globally. Five-year survival rates with current modalities of treatment for anal cancer are generally favorable for localized and regional disease. For metastatic disease, the relative survival rate is poor. Major contributing factors for the increase in anal cancer incidence include increasing receptive anal intercourse (hetero- and homosexual), increasing HPV infections, and longer life expectancy of treated people who are seropositive for human immunodeficiency virus. Because treatment outcomes with systemic therapy in patients with advanced disease are so poor, prevention may be the best approach for reducing disease burden. The association of a major causative agent with anal cancer provides an excellent opportunity for prevention and treatment. The advent of the HPV vaccine for anal cancer prevention and treatment is a significant milestone and has the potential to greatly impact these cancers. The data regarding potential use of the HPV vaccine in anal cancer prevention and treatment are reviewed. Implications for Practice: The incidences of human papillomavirus (HPV)-related anal cancer and its precursor lesion, anal intraepithelial neoplasia, are on the rise in the U.S. and globally. Based on recent studies, the HPV vaccine is approved for prevention of the infection and development of HPV-related anal cancer. In addition, several small studies have shown that the vaccine may be useful as adjuvant therapy for anal cancer. There is a need for public health strategies aimed at education of both patients and practitioners to improve the use of the vaccine for prevention of HPV-related anal cancer. The development of a therapeutic vaccine is a work in progress. PMID:26961923

  11. The Human Papillomavirus Vaccine: Current Perspective and Future Role in Prevention and Treatment of Anal Intraepithelial Neoplasia and Anal Cancer.

    PubMed

    Mensah, Felix A; Mehta, Mudresh R; Lewis, James S; Lockhart, A Craig

    2016-04-01

    The incidences of human papillomavirus (HPV)-related anal cancer and its precursor lesion, anal intraepithelial neoplasia, are rising in the U.S. and globally. Five-year survival rates with current modalities of treatment for anal cancer are generally favorable for localized and regional disease. For metastatic disease, the relative survival rate is poor. Major contributing factors for the increase in anal cancer incidence include increasing receptive anal intercourse (hetero- and homosexual), increasing HPV infections, and longer life expectancy of treated people who are seropositive for human immunodeficiency virus. Because treatment outcomes with systemic therapy in patients with advanced disease are so poor, prevention may be the best approach for reducing disease burden. The association of a major causative agent with anal cancer provides an excellent opportunity for prevention and treatment. The advent of the HPV vaccine for anal cancer prevention and treatment is a significant milestone and has the potential to greatly impact these cancers. The data regarding potential use of the HPV vaccine in anal cancer prevention and treatment are reviewed. The incidences of human papillomavirus (HPV)-related anal cancer and its precursor lesion, anal intraepithelial neoplasia, are on the rise in the U.S. and globally. Based on recent studies, the HPV vaccine is approved for prevention of the infection and development of HPV-related anal cancer. In addition, several small studies have shown that the vaccine may be useful as adjuvant therapy for anal cancer. There is a need for public health strategies aimed at education of both patients and practitioners to improve the use of the vaccine for prevention of HPV-related anal cancer. The development of a therapeutic vaccine is a work in progress. ©AlphaMed Press.

  12. Breeding for rice fissure resistance made possible through development of a new selection technique and identification of molecular gene tags

    USDA-ARS?s Scientific Manuscript database

    Value: One of the primary causes of rice grain breakage during milling is fissuring, or cracking, of the rice before it enters the mill. Any reduction in kernel fissuring can result in direct increases in profit for both producers and millers. For a producer yielding 7,000 lb/A paddy, even a small (...

  13. 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

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

    PubMed

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

    2017-02-15

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

  15. 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.

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

    ClinicalTrials.gov

    2017-09-04

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

  17. Psychological stress in patients with anal fistula.

    PubMed

    Cioli, V M; Gagliardi, G; Pescatori, M

    2015-08-01

    Psychological stress is known to affect the immunologic system and the inflammatory response. The aim of this study was to assess the presence of psychological stress, anxiety, and depression in patients with anal fistula. Consecutive patients with anal fistula, hemorrhoids, and normal volunteers were studied prospectively. Stressful life events were recorded and subjects were asked to complete the state-trait anxiety inventory (STAI), a depression scale, and three different reactive graphic tests (RGT). Seventy-eight fistula patients, 73 patients with grade III-IV hemorrhoids, and 37 normal volunteers were enrolled. Of the fistula patients, 65 (83 %) reported one or more stressful events in the year prior to diagnosis, compared to 16 (22 %) of the hemorrhoid patients (P = 0.001). There were no significant differences in the percentage of subjects with abnormal trait anxiety (i.e., proneness for anxiety) and depression scores between fistula patients, hemorrhoid patients, and controls. Fistula patients had significantly higher (i.e., better) scores compared to hemorrhoid patients in two of three RGT and significantly lower (i.e., worse) scores in all three RGT compared to healthy volunteers. Of 37 patients followed up for a median of 28 months (range 19-41 months) after surgery, 8 (21.6 %) had persistent or recurrent sepsis. There was no significant difference in depression, STAI, and RGT scores between patients with sepsis and patients whose fistula healed. Our results suggest that an altered emotional state plays an important role in the pathogenesis of anal fistula and underline the importance of psychological screening in patients with anorectal disorders.

  18. Efficacy of LIFT for recurrent anal fistula.

    PubMed

    Lehmann, J-P; Graf, W

    2013-05-01

    Ligation of the intersphincteric fistula tract (LIFT) is a novel sphincter-preserving technique for anal fistula. This pilot study was designed to evaluate the results in patients with a recurrent fistula. Seventeen patients [nine men; median age 49 (range, 30-76) years] with a recurrent trans-sphincteric fistula were treated with a LIFT procedure between June 2008 and February 2011. All were followed prospectively for a median of 16 (range, 5-27) weeks with clinical examination. Fifteen followed for 13.5 (range, 8-26) months by clinical examination also had three-dimensional (3D) anal ultrasound. The duration of the procedure was 35 (range, 18-70) min. One patient developed a small local haematoma and one had a subcutaneous infection, but otherwise there was no morbidity. At follow up, 11 (65%) patients had a successful closure, two (12%) had a remaining sinus and four (23%) had a persistent fistula. The incidence of persistent or recurrent fistulae at 13.5 months was six (40%) of 15 patients. No de novo faecal incontinence was reported. LIFT is a safe procedure for patients with recurrent anal fistula, with healing at short-term and medium-term follow-up comparable with or superior to that of other sphincter-preserving techniques. Larger studies with a longer follow up are needed to define the ultimate role of LIFT in patients with recurrence. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  19. Randomized Clinical Trials in Localized Anal Cancer.

    PubMed

    Smith, Clayton A; Kachnic, Lisa A

    2017-10-01

    Management of anal carcinoma began as abdominoperineal resection and has evolved to combined chemotherapy and radiation. Early randomized trials demonstrated superior clinical outcomes of combined modality therapy over radiotherapy alone. Subsequent trials investigated alterations in the standard backbone of radiotherapy concurrent with 5-fluorouracil and mitomycin C with intent to maintain clinical outcomes while reducing treatment-related morbidity. The addition of intensity-modulated radiotherapy to radiation planning and delivery has subsequently reduced acute toxicity and detrimental treatment breaks. Ongoing and future trials are aimed at reducing therapy in favorable patient populations to decrease morbidity while intensifying treatment in patients with negative prognostic factors. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Treatment of anal stenosis: a 5-year review.

    PubMed

    Casadesus, Damian; Villasana, Luis E; Diaz, Hector; Chavez, Mariano; Sanchez, Ines M; Martinez, Pedro P; Diaz, Angelina

    2007-07-01

    Benign anal stenosis is an uncommon, disabling and incapacitating disease, occurring mainly after anorectal surgery. Both non-surgical and surgical treatments have been devised in the treatment of anal stenosis with good results. We described the results of the treatment of this disease in the Coloproctology Department of our institution. A retrospective clinical study was undertaken over a 5-year period for consecutive patients operated on for anal stenosis. Twenty-three patients with benign anal stenosis were treated in our department. Haemorrhoidectomy was the most common cause of anal stenosis (74%). Nineteen patients with moderate to severe symptoms of anal stenosis underwent surgical treatment. Lateral mucosal advancement flap was the most frequently carried out operation (63.1%). Four patients were treated with anal dilatation (17.3%). All patients had remission of the preoperative symptoms. There was no re-operation and only minor complications were present in four patients: three patients with anal pruritus and one patient with temporary incontinence. The easy performance, the absence of major complications and the good results obtained confirm that these methods are effective and safe in the treatment of anal stenosis.

  1. 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

  2. Condyloma Acuminatum, Anal Intraepithelial Neoplasia, and Anal Cancer in the Setting of HIV: Do We Really Understand the Risk?

    PubMed

    Fazendin, Edward A; Crean, Alexander J; Fazendin, Jessica M; Kucejko, Robert J; Gill, Harkenwar S; Poggio, Juan L; Stein, David E

    2017-10-01

    The gold standard for surveillance of patients with anal lesions is unclear. The aim of this study was to stratify patients for risk of progression of disease and to determine appropriate intervals for surveillance of patients with anal disease. This was a retrospective chart review for patients treated for anal lesions between 2007 and 2014. Only patients with ≥1 year of follow-up from index evaluation, pathology, documented physical examination, and anoscopy findings were included for analysis. The study was conducted at an urban university hospital. HIV-positive patients with anal lesions treated with excision and fulguration were included. Recurrence of anal lesions, progression of disease, and progression to cancer were measured. Ninety-one patients met inclusion criteria. The mean age was 41.6 years, and mean follow-up was 38.6 months (range, 11.0-106.0 mo). On initial pathology, 8 patients (8.8%) had a diagnosis of condyloma acuminatum without dysplasia, 20 patients (22%) had anal intraepithelial neoplasia I, 32 (35.2%) had anal intraepithelial neoplasia II, and 31 (34.1%) had anal intraepithelial neoplasia III. Sixty-nine patients (75.8%) had repeat procedures. Seven (87.5%) of 8 patients with condyloma and 6 (30%) of 20 patients with anal intraepithelial neoplasia I progressed to high-grade lesions. Five (15.6%) of 32 patients progressed from anal intraepithelial neoplasia II to III, and 2 patients with anal intraepithelial neoplasia III (6.5%) developed squamous cell carcinoma (2.3% for the entire cohort). This was a single institution study. High-resolution anoscopy was not used. All of the HIV-positive patients with condyloma or anal intraepithelial neoplasia, regardless of the presence of dysplasia, should be surveyed at equivalent 3-month time intervals, because their risk of progression of disease is high. Video Abstract at http://links.lww.com/DCR/A389.

  3. Giant desiccation fissures on the Black Rock and Smoke Creek Deserts, Nevada

    USGS Publications Warehouse

    Willden, R.; Mabey, D.R.

    1961-01-01

    Open fissures, from 100 to several hundred feet apart, that have produced polygonal patterns on the Black Rock Desert, Nevada, are believed to be giant desiccation cracks resulting from a secular trend toward aridity in the last few decades. Similar features on the Smoke Creek Desert probably have the same origin.

  4. Identification of genetic loci underlying the kernel fissure-resistance exhibited by 'cypress' and 'saber'

    USDA-ARS?s Scientific Manuscript database

    The economic value of broken rice is about half that of whole milled rice, so one goal of producers, millers, and rice breeders is to reduce broken grains that result from the dehusking and milling processes One of the primary causes of rice breakage is fissuring, or cracking, of the rice before it ...

  5. Rice fissure resistance QTLs from ‘Saber’ complement those from ‘Cypress’

    USDA-ARS?s Scientific Manuscript database

    The economic value of broken rice is about half that of whole milled rice, so one goal of producers, millers, and rice breeders is to reduce grain breakage during the dehusking and milling processes. One of the primary causes of rice breakage is fissuring, or cracking, of the rice before it enters ...

  6. Evaluation of pumice, fissure enameloplasty and air abrasion on sealant microleakage.

    PubMed

    Blackwood, Julie A; Dilley, Diane C; Roberts, Michael W; Swift, Edward J

    2002-01-01

    The purpose of this in vitro study was to evaluate microleakage of pit and fissure sealants after using three different pit and fissure preparation techniques: (1) traditional pumice prophylaxis and acid etching, (2) fissure enameloplasty and acid etching and (3) air abrasion and acid etching. Sixty extracted third molars with no clinical evidence of caries were randomly divided into 3 groups of 20 each. Teeth were prepared using 1 of 3 occlusal surface treatments prior to placement of Delton opaque light-cured sealant. The teeth were thermocycled between 5 +/- 2 degrees C and 55 +/- 2 degrees C for 500 cycles with a dwell time of 30 seconds and then stored in 0.9% normal saline. All teeth were sealed apically and coated within 1.5 mm of the sealant margin with two layers of nail varnish. The teeth were immersed in a 1% solution of methylene blue for 24 hours to allow dye penetration into possible gaps between enamel and sealant. Three buccolingual cuts parallel to the long axis of the tooth were made yielding 4 sections and 6 surfaces per tooth for analysis. The surfaces were scored 0 to 3 for extent of microleakage using a binocular microscope at 25X magnification. Kruskal-Wallis and t tests revealed no significant difference in microleakage between the 3 fissure preparation methods prior to sealant placement. Neither air abrasion nor enameloplasty followed by acid etching produced significantly less microleakage than the traditional pumice prophylaxis with acid etching technique.

  7. Microleakage assessment of fissure sealant following fissurotomy bur or pumice prophylaxis use before etching.

    PubMed

    Bagherian, Ali; Akbari, Majid; Rezaeian, Mohsen; Ansari, Ghassem

    2013-09-01

    A prolonged life of fissure sealant has always been the target for preventing caries in vulnerable newly erupted teeth. The use of preparatory techniques including bur introduction to the fissures is considered among such improving steps. Ninety freshly extracted healthy maxillary premolar teeth were randomly selected for this investigation. Teeth were then divided into three fissure sealant preparatory groups of A: Fissurotomy bur + acid etch; B: Pumice prophylaxis + acid etch and C: Acid etch alone. Sealant was applied to the occlusal fissures of all specimens using a plastic instrument. This was to avoid any air trap under the sealant. Sample teeth were first thermocycled (1000 cycles, 20 s dwell time) and then coated with two layers of nail varnish leaving 2 mm around the sealant. This was then followed by immersion in basic fuchsin 3%. Processed teeth were sectioned longitudinally and examined under a stereomicroscope for microleakage assessment using a score of 0-3. Collected data was then subjected to Kruskall-Wallis Analysis of Variance and Mann-Whitney U-test. P > 0.05 was considered as significant. Teeth in fissurotomy bur and pumice prophylaxis groups had significantly reduced level of microleakage than those in acid etch alone (P = 0.005 and P = 0.003, respectively). Use of fissurotomy bur and pumice prophylaxis accompanied with acid etching appears to have a more successful reduction of microleakage than acid etch alone.

  8. Microleakage assessment of fissure sealant following fissurotomy bur or pumice prophylaxis use before etching

    PubMed Central

    Bagherian, Ali; Akbari, Majid; Rezaeian, Mohsen; Ansari, Ghassem

    2013-01-01

    Background: A prolonged life of fissure sealant has always been the target for preventing caries in vulnerable newly erupted teeth. The use of preparatory techniques including bur introduction to the fissures is considered among such improving steps. Materials and Methods: Ninety freshly extracted healthy maxillary premolar teeth were randomly selected for this investigation. Teeth were then divided into three fissure sealant preparatory groups of A: Fissurotomy bur + acid etch; B: Pumice prophylaxis + acid etch and C: Acid etch alone. Sealant was applied to the occlusal fissures of all specimens using a plastic instrument. This was to avoid any air trap under the sealant. Sample teeth were first thermocycled (1000 cycles, 20 s dwell time) and then coated with two layers of nail varnish leaving 2 mm around the sealant. This was then followed by immersion in basic fuchsin 3%. Processed teeth were sectioned longitudinally and examined under a stereomicroscope for microleakage assessment using a score of 0-3. Collected data was then subjected to Kruskall-Wallis Analysis of Variance and Mann-Whitney U-test. P > 0.05 was considered as significant. Results: Teeth in fissurotomy bur and pumice prophylaxis groups had significantly reduced level of microleakage than those in acid etch alone (P = 0.005 and P = 0.003, respectively). Conclusion: Use of fissurotomy bur and pumice prophylaxis accompanied with acid etching appears to have a more successful reduction of microleakage than acid etch alone. PMID:24348623

  9. Resistance to subsidence of an uncemented femoral stem after cerclage wiring of a fissure.

    PubMed

    McCulloch, Ryan S; Roe, Simon C; Marcellin-Little, Denis J; Mente, Peter L

    2012-01-01

    To compare: (1) the force required to initiate subsidence, and (2) the relative subsidence, of femoral stems implanted into intact femora, and then into the same femora in which an induced fissure had been stabilized by cerclage. In vitro, mechanical study. Femora (n=9) from 9 dogs. Femora were prepared for implantation of an uncemented stem. Stems were implanted with continuous and impact loading. After axial loading until a fissure occurred, the stems were extracted, and the fissure stabilized with double-loop cerclage. Stems were reimplanted, and reloaded to failure. Mean±SD load to initiate subsidence in intact femora was 1706±584 N compared with 2379±657 N for cerclaged bones (P=.002). Mean relative subsidence of intact femora was 3.99±2.09 mm compared with 1.79±2.99 mm for cerclaged bones (P=.091). The load to initiate subsidence is increased in femora that have fissured, then have been stabilized with double-loop cerclage, when compared with intact femora. The relative subsidence is not different between intact and stabilized specimens. © Copyright 2011 by The American College of Veterinary Surgeons.

  10. Influence of matrix diffusion and exchange reactions on radiocarbon ages in fissured carbonate aquifers

    SciTech Connect

    Maloszewski, P. ); Zuber, A. )

    1991-08-01

    The parallel fissure model coupled with the equation of diffusion into the matrix and with exchange reaction equations has been used to derive a simple formula for estimating the influence of matrix porosity and reaction parameters on the determination of radiocarbon ages in fissured carbonate rocks. Examples of evidently too great radiocarbon ages in carbonate formations, which are not explainable by models for the initial {sup 14}C corrections, can easily be explained by this formula. Parameters obtained for a chalk formation from a known multitracer experiment combined with a pumping test suggest a possibility of {sup 14}C ages more than three orders of magnitude greater than the ages which would be observed if the radiocarbon transport took place only in the mobile water in the fissures. It is shown that contrary to the solute movement on a small scale and with a variable input, the large-scale movement, characteristic for the {sup 14}C dating, does not necessarily require the knowledge of kinetic parameters, because they may be replaced by the distribution coefficient. Discordant tritium and {sup 14}C concentrations are commonly interpreted as a proof of mixing either in the aquifer or at the discharge site. For fissured carbonate formations, however, an alternative explanation is given by the derived model showing a considerable delay of {sup 14}C with respect to nonsorbable tracers.

  11. Mapping the fissure potential zones based on microtremor measurement in Denpasar City, Bali

    NASA Astrophysics Data System (ADS)

    Prabowo, U. N.; Marjiyono; Sismanto

    2016-01-01

    Denpasar City and its vicinity considered as the areas with excessive ground water exploitation and high earthquake intensity. These conditions will cause these area potential with land subsidence which is triggering ground fissures. This research aims are to mapping the fissures potential areas based on microtremor measurement in Denpasar City and its vicinity. Ground fissures will happen if the land subsidence occurs in the areas which have different bedrock height beneath its sedimentary layer. The height of bedrock is determined by reducing surface elevation with the sedimentary layer thickness. This sedimentary layer thickness obtained from microtremor measurement using HVSR method, and Shear wave velocity (VS) obtained from microtremor array measurement which is analyzed by Spatial Auto Correlation (SPAC) method. The result from HVSR method as well as Peak Ground Acceleration (PGA) value are then analyzed to get ground shear strain value, which is the soil surface strain and its effect when earthquake occurs. Based on the bedrock map, it can be estimated that the bedrock layer forms structure in the southern part of the research areas and the potential fissuring area due to the massive ground water exploitation is in the west Denpasar Subdistrict. In addition, based on the bedrock map and ground shear strain value which combined with Simple Additive Weight (SAW) method, there are two areas having Assuring potential, i.e west and south Denpasar Subdistricts.

  12. Tensions and Fissures: The Politics of Standardised Testing and Accountability in Ontario, 1995-2015

    ERIC Educational Resources Information Center

    Pinto, Laura Elizabeth

    2016-01-01

    While Ontario has received international accolades for its enactment of province-wide standardised testing upon the formation of the Education Quality and Accountability Office (EQAO), a closer look at provincial assessments over a 20-year span reveals successes as well as systemic tensions and fissures. The purpose of this paper is twofold.…

  13. Impact of extended radiant exposure time on polymerization depth of fluoride-containing fissure sealer materials.

    PubMed

    Borges, Boniek C D; Souza-Junior, Eduardo J; Catelan, Anderson; Ambrosano, Gláucia M B; Paulillo, Luís A M S; Aguiar, Flávio H B

    2011-01-01

    Physical properties such as surface hardness of dental materials are directly linked to their clinical behavior. The aim of this study was to investigate the influence of extended curing time on the polymerization depth offluoride-containing materials used as pit and fissure sealants. Conventional and extended exposure times (20 and 60 seconds) were used to photoactivate a gold-standard pit and fissure sealant (Fluroshield, Dentsply) and a flowable composite (PermaFlo, Ultradent). Twenty square-shaped samples (n=5) were prepared using a LED device (Bluephase 16i, Ivoclar). The Knoop Hardness Number (KHN) was calculated for the top and bottom surface of each sample 24 hours after polymerization. Bottom/top hardness ratio (B/T KHN) was than calculated. Averages were analyzed by two-way ANOVA and Tukey test (alpha=0.05). The flowable composite had higher KHN than conventional pit and fissure sealant for all experimental conditions (p<0.05). The 60-second photoactivation time increased KHN at the bottom surface and B/T KHN only of composite specimens. The flowable composite had better physical properties than the pit and fissure sealant, and they were improved by extended curing time.

  14. Tensions and Fissures: The Politics of Standardised Testing and Accountability in Ontario, 1995-2015

    ERIC Educational Resources Information Center

    Pinto, Laura Elizabeth

    2016-01-01

    While Ontario has received international accolades for its enactment of province-wide standardised testing upon the formation of the Education Quality and Accountability Office (EQAO), a closer look at provincial assessments over a 20-year span reveals successes as well as systemic tensions and fissures. The purpose of this paper is twofold.…

  15. 21 CFR 872.3765 - Pit and fissure sealant and conditioner.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pit and fissure sealant and conditioner. 872.3765 Section 872.3765 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... depressions (faults in the enamel) in the biting surfaces of teeth to prevent cavities. (b)...

  16. 21 CFR 872.3765 - Pit and fissure sealant and conditioner.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pit and fissure sealant and conditioner. 872.3765 Section 872.3765 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... depressions (faults in the enamel) in the biting surfaces of teeth to prevent cavities. (b)...

  17. 21 CFR 872.3765 - Pit and fissure sealant and conditioner.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pit and fissure sealant and conditioner. 872.3765 Section 872.3765 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... depressions (faults in the enamel) in the biting surfaces of teeth to prevent cavities. (b)...

  18. 21 CFR 872.3765 - Pit and fissure sealant and conditioner.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pit and fissure sealant and conditioner. 872.3765 Section 872.3765 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... depressions (faults in the enamel) in the biting surfaces of teeth to prevent cavities. (b)...

  19. 21 CFR 872.3765 - Pit and fissure sealant and conditioner.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pit and fissure sealant and conditioner. 872.3765 Section 872.3765 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... depressions (faults in the enamel) in the biting surfaces of teeth to prevent cavities. (b)...

  20. Prevalence of anal symptoms in general practice: a prospective study.

    PubMed

    Tournu, Géraldine; Abramowitz, Laurent; Couffignal, Camille; Juguet, Frédéric; Sénéjoux, Agnès; Berger, Stéphane; Wiart, Anne-Laure; Bernard, Marc; Provost, Françoise; Pillant-Le Moult, Hélène; Bouchard, Dominique; Aubert, Jean-Pierre

    2017-08-03

    Anal disorders are largely underestimated in general practice. Studies have shown patients conceal anal symptoms leading to late diagnosis and treatment. Management by general practitioners is poorly described. The aim of this study is to assess the prevalence of anal symptoms and their management in general practice. In this prospective, observational, national study set in France, all adult patients consulting their general practitioner during 2 days of consultation were included. Anal symptoms, whether spontaneously revealed or not, were systematically collected and assessed. For symptomatic patients, the obstacles to anal examination were evaluated. The general practitioner's diagnosis was collected and a proctologist visit was systematically proposed in case of anal symptoms. If the proctologist was consulted, his or her diagnosis was collected. From October 2014 to April 2015, 1061 patients were included by 57 general practitioners. The prevalence of anal symptoms was 15.6% (95% CI: 14-18). However, 85% of these patients did not spontaneously share their symptoms with their doctors, despite a discomfort rating of 3 out of 10 (range 1-5). Although 65% of patients agreed to an anal examination, it was not proposed in 45% of cases with anal symptoms. Performing the examination was associated with a significantly higher diagnosis rate of 76% versus 20% (p < 0.001). Proctologist and general practitioner diagnoses were consistent in 14 out of 17 cases. Patients' concealed anal symptoms are significant in general practice despite the impact on quality of life. Anal examination is seldom done. Improved training of general practitioners is required to break the taboo.

  1. [Comparison of oncology outcomes and anal function among laparoscopic partial, subtotal and total intersphincteric resection for low rectal cancers].

    PubMed

    Zhang, Bin; Liu, Quanlong; Zhao, Yujuan; Zhuo, Guangzuan; Yin, Shuhui; Zhu, Jun; Zhao, Ke; Ding, Jianhua

    2017-08-25

    classification among 3 groups (all P>0.05). However, patients with chronic anastomotic stoma stenosis showed worse anal function than those without stenosis [Wexner incontinence score: 18(9-20) vs 6(0-18), P=0.000; Kirwan grading: 3(2-4) vs. 2(1-4), P=0.002]. As the ultimate sphincter-saving technique, laparoscopic ISR can result in better oncologic outcomes and better anal function for patients with low rectal cancers. The different procedures of ISR may not affect the efficacy, but chronic anastomotic stoma stenosis deteriorates incontinence status.

  2. Methods for monitoring land subsidence and earth fissures in the Western USA

    NASA Astrophysics Data System (ADS)

    Fergason, K. C.; Rucker, M. L.; Panda, B. B.

    2015-11-01

    Depletion of groundwater resources in many deep alluvial basin aquifers in the Western USA is causing land subsidence, as it does in many regions worldwide. Land subsidence can severely and adversely impact infrastructure by changing the ground elevation, ground slope (grade) and through the development of ground cracks known as earth fissures that can erode into large gullies. Earth fissures have the potential to compromise the foundations of dams, levees, and other infrastructure and cause failure. Subsequent to an evaluation of the overall subsidence experienced in the vicinity of subsidence-impacted infrastructure, a detailed investigation to search for earth fissures, and design and/or mitigation of potentially effected infrastructure, a focused monitoring system should be designed and implemented. Its purpose is to provide data, and ultimately knowledge, to reduce the potential adverse impacts of land subsidence and earth fissure development to the pertinent infrastructure. This risk reduction is realized by quantifying the rate and distribution of ground deformation, and to detect ground rupture if it occurs, in the vicinity of the infrastructure. The authors have successfully designed and implemented monitoring systems capable of quantifying rates and distributions of ground subsidence and detection of ground rupture at multiple locations throughout the Western USA for several types of infrastructure including dams, levees, channels, basins, roadways, and mining facilities. Effective subsidence and earth fissure monitoring requires understanding and quantification of historic subsidence, estimation of potential future subsidence, delineation of the risk for earth fissures that could impact infrastructure, and motivation and resources to continue monitoring through time. A successful monitoring system provides the means to measure ground deformation, grade changes, displacement, and anticipate and assess the potential for earth fissuring. Employing multiple

  3. Effect of an Antibacterial Monomer on the Antibacterial Activity of a Pit-and-Fissure Sealant

    PubMed Central

    Dong, Yan; Zhang, Ling; Sun, Xiang; Liu, Zhengya; Guo, Huihui; Huang, Li; Chen, Jihua

    2016-01-01

    Resin-based pit-and-fissure sealants are often used to form a barrier on the occlusal surface of molars to treat caries lesions; however, bacteria can remain in the pit and fissures without detection, increasing the risk of secondary caries. Sealants with antimicrobial properties or microbial repellent actions might be advantageous. The aim of this study was to assess the inhibitory effect of a 2-methacryloxylethyl dodecyl methyl ammonium bromide (MAE-DB)-incorporated sealant against Streptococcus mutans. MAE-DB (4% wt) was incorporated into a commercially available sealant, Eco-S resin-based pit-and-fissure sealant (Vericom Co., Ltd., Korea); a sealant without MAE-DB served as a negative control, and Clinpro™ Sealant (3M™ ESPE™), a fluoride-releasing resin, was used as a commercial control. The effects of the cured sealants and their eluents on the growth of S. mutans were determined according to colony-forming unit counts and metabolic tests. The effects of the cured sealants on the adherence and membrane integrity of S. mutans were investigated using confocal laser-scanning microscopy (CLSM) in conjunction with fluorescent indicators. Compared with the negative control and commercial control, the cured MAE-DB-incorporated pit-and-fissure sealant exhibited a significant inhibitory effect on the growth of S. mutans (P < 0.05), whereas the eluents did not show any detectable antibacterial activity. The commercial control also showed no detectable bactericidal activity. Moreover, the aged experimental material retained its property of contact inhibition of biofilm formation. The fluorescence analysis of CLSM images demonstrated that the cured MAE-DB-incorporated sealant could hamper the adherence of S. mutans and exert a detrimental effect on bacterial membrane integrity. The incorporation of MAE-DB can render a pit-and-fissure sealant with contact antibacterial activity after polymerization via influencing the growth, adherence, and membrane integrity of S

  4. Microleakage, adaptation ability and clinical efficacy of two fluoride releasing fissure sealants.

    PubMed

    Marković, Dejan; Petrović, Bojan; Perić, Tamara; Blagojević, Duska

    2012-04-01

    Retention of fissure sealants and good adaptation to enamel are essential for their success. Fluoride releasing resin-based materials are widely accepted for pit and fissure sealing, but newly designed glass ionomers can serve as a good alternative. The aim of this study was to evaluate microleakage and sealing ability in vitro, and to clinically assess two fluoride releasing fissure sealants. The sample for experimental study consisted of 20 freshly extracted intact human third molars, divided in two experimental groups according to the sealing material: fluoride releasing resin-based (Heliosel F) and glass ionomer (Fuji Triage) material. Digital images and scanning electron microscope were used to assess microleakage and adaptation ability. Sample for clinical study consisted of 60 children, aged 6-8 years, with high caries risk, divided in two groups according to the sealant material. Fissure sealant was applied to all erupted, caries-free first permanent molars. Sealants were evaluated after 3, 6 and 12 months using modified Ryge criteria for retention, marginal adaptation, colour match, surface smoothness and caries. Microleakage was detected in more than half of the specimen, without significant differences between the two groups (p > 0.05). Both materials exhibited acceptable sealing ability. Complete retention at the end of the observation period was 81.8% for resin-based, and 21.1% for glass-ionomer fissure sealant (p < 0.001). The presence of caries in sealed molars has been detected in one patient in both groups. During the 12-month observation period, Helioseal F demonstrated better retention, marginal adaptation and surface smoothness (p < 0.001). There were no differences between the two materials regarding caries and color match (p > 0.05). Both tested materials demonstrate satisfactory clinical and caries prophylactic characteristics that justify their use in contemporary preventive dentistry.

  5. Anal cancer and intraepithelial neoplasia screening: A review

    PubMed Central

    Leeds, Ira L; Fang, Sandy H

    2016-01-01

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

  6. Effects of pregnancy, parturition, and anal sphincter transection on function of the external anal sphincter in an animal model.

    PubMed

    Rahn, David D; White, Amanda B; Miller, Rodney T; Word, R Ann; Wai, Clifford Y

    2009-04-01

    To estimate the effects of pregnancy, parturition, and anal sphincter laceration (with repair) on external anal sphincter morphology and neurophysiology and to define the time course of these effects after injury. Within 4 hours of vaginal delivery, 80 rats underwent either sham or anal sphincter laceration with repair. After 3 days, 3 weeks, and 3 and 6 months (n=20 for each time point), animals were killed, and the anal sphincter complexes dissected and removed for neurophysiologic studies. Twitch tension, peak tetanic force, fatigue, and maximal electrical field-stimulated force generation were determined. Sphincters were then fixed and serially sectioned (5-micrometer thickness) at 100-micrometer intervals for histologic analysis. Maximal electrical field-stimulated force generation, maximal tetanic contraction, and twitch tension were decreased in the external anal sphincter 3 days after anal sphincter laceration with repair compared with sham-operated parturient rats (3.3 g compared with 11.6 g, 4.5 g compared with 14.5 g, and 0.6 g compared with 2.0 g, respectively, all P<.02). Increased fatigability of the sphincter muscle was observed in all newly parturient rats-sham and anal sphincter laceration with repair; recovery occurred in the shams by 3 months. A gradual recovery occurred in all these neurophysiologic measures, with no significant differences between anal sphincter laceration with repair and shams by 6 months postpartum. Repaired anal sphincter transection in periparturient animals results in short-term severe compromise of neurophysiologic function of the external anal sphincter. Over time, however, force generation recovers and approximates that of postpar