Anal canal and perianal epidermoid cancers

Squamous cell carcinoma of the anal canal serves as a paradigm for the successful application of multimodality treatment of solid tumors. Since 1974, multimodality treatment with combined radiation and chemotherapy has become the standard. The compelling advantage of sphincter preservation and the substantial survival benefit compared with surgery alone prompted investigators to adopt chemoradiation treatment. Several questions regarding the optimal radiation dose and chemotherapy in initial as well as salvage therapy remain, and only recently have results of several prospective randomized studies become available to address some of these unresolved issues. We reviewed the clinical aspects and historical treatment results of anal canal and perianal epidermoid cancers in light of the results of these modern trials. Current management strategies are redefined, and future directions of clinical studies are outlined.     

Anal and perianal lesions in Crohn's disease]

Crohn's disease is not a homogeneous clinical entity but may shows many clinical pictures during its period, prognosis and response to therapy. Anal and perianal localisations are frequently found; they can occur isolated, months or years in advance the disease, or can be concomitant with an ileal, colic or rectal involvement. There can be many kinds of lesions: simple, such as eczema or fissuration, complex, such as high rectal or rectovaginal fistulas. A rational classification of anal and perianal manifestations is suggested. Local medical therapy, is very effective in minor lesions, and has to be associated with systemic medical therapy particularly nowadays: the knowledge on phlogosis, biology and biotechnology revolution, have launched a new therapeutic era. Surgical therapy can be performed only in case of complex disease non responsive to medical therapy or when it is necessary to give a rest to anorectal tract. To perform a correct follow-up, considering unpredictability of lesions, a careful clinical evaluation and an intensive surveying plan associated with objective evaluation parameters are suggested.     

Anal,perianal, perineal and sacrococcygeal sinuses

In accordance with the accepted definitions of “sinus” and “fistula” an attempt has been made to indicate those lesions which are true fistulas and those which are true sinuses in the anal, perianal, perineal and sacrococcygeal regions.Inasmuch as the great majority of socalled “draining sinuses” in the anal, perianal and perineal skin are in reality the secondary openings of true anal fistulas, an effort has been made to clarify the pathogenesis of anal fistula. It is hoped that a proper understanding of this mechanism will lead to more accurate diagnosis and to adequate management.Pilonidal cyst is the most common “developmental” lesion dorsal to the sacrum and coccyx.The essential differential diagnostic features of anal, perianal, perineal and sacrococcygeal sinuses have been briefly stated.     

Anal endosonography in the evaluation of perianal sepsis and fistula in ano

Anal endosonography has been performed in 22 patients with fistula in ano and perianal sepsis and compared with the operative findings. Using a special hard cone attachment to a radial 7 MHz probe the examination was well tolerated, rapid and generally accurate, detecting two unsuspected foreign bodies and all seven complicated fistula in ano preoperatively.     

Carcinogenic perianal fistula

The paper reports a case of anal fistula which led to the formation of a muco-secreting adenocarcinoma. The case is described in the context of other published case reports.     

Gas-producing perianal infection

Five cases of nonclostridial, gas-producing perianal infection are reported and the resemblance to clostridial gas gangrene is discussed. The importance of early diagnosis followed by aggressive surgical debridement and prompt administration of broad-spectrum antibiotics is emphasized.     

微波配合序贯扩肛治疗陈旧性肛裂疗效观察

目的 分析、比较2种治疗陈旧性肛裂方法的临床疗效和特点.方法 将96例陈旧性肛裂患者按就诊单双号分成2组:观察组48例,行微波配合序贯扩肛治疗;对照组48例,行后位内括约肌部分切断.对2种方法的术中出血量、创口愈合时间、创口感染率、肛门感染率、肛门控制情况、术后排便改善情况、肛门狭窄发生率及复发率进行比较分析.结果 观察组的术中出血量及创口愈合时间均少于对照组(P<0.01),肛门控制情况优于对照组(P<0.05).2组患者术后均无创口感染及肛门感染病例发生.2组术后随访1年,均无复发病例,术后排便情况均得到改善,观察组肛门狭窄发生率低于对照组(P<0.05).结论 微波配合序贯扩肛治疗陈旧性肛裂简便易行,患者痛苦小、效果好,值得推广.     

Anal fissure and stenosis

Fissure in ano is a simple condition that causes considerable discomfort. The acute forms should be treated by conservative nonsurgical regimens initially. If the patient finds the symptoms intolerable, or if the fissure demonstrates signs of chronicity, then lateral subcutaneous sphincterotomy is recommended as an ideal simple surgical procedure that has the advantages of a low complication rate and low morbidity. It is easily performed under local anesthesia and does not require hospitalization. It is gratifyingly satisfying for both the patient and surgeon. Certain types of anal stenosis, especially those following hemorrhoidectomy, are successfully managed by lateral sphincterotomy combined with postoperative anal dilatation. This approach avoids the more complicated plastic anal procedures that have been used in the past.     

Anal Canal Pressure in Anal Fissure Before and After Internal Sphincterotomy

Purpose: To assess whether the anal canal pressure is increased in patients with a chronic anal fissure and to examine the effects of internal anal sphincterotomy (IASy) on this pressure.

Materials and method: Anorectal manometry was performed in 28 patients in whom an anal fissure had been diagnosed by means of physical examination and anuscopy. After IASy the manometric measurement was repeated on the 15^th postoperative day and compared with the value obtained in twelve healthy volunteers.

Results: In patients with chronic anal fissure, the mean maximal resting pressure (MRP) was found to be 112.38 ± 8.35 cm H20 pre-operatively and 66.23 ± 8.44 cm H20 postoperatively, with a significant drop after IASy (p < 0.001). The MRP value was found as 75.16 ±10.22 cm H20 in the control group. The pre-operative MRP values in patient group was found to be higher than in the control group (p < 0.001).

Conclusions: In patients with chronic anal fissure, the anal canal MRP pressures decreased significantly following IASy and complete clinical recovery was attained.     

Anal fissure

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