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Neuropathy may cause fecal incontinence and mixed fecal incontinence/constipation, but its prevalence is unclear, partly due to the lack of comprehensive testing of spino-anorectal innervation.This study aimed to develop and determine the clinical usefulness of a novel test, translumbosacral anorectal magnetic stimulation for fecal incontinence.This observational cohort study was conducted from 2012 to 2018.This study was performed at a tertiary referral center.Patients with fecal incontinence, patients with mixed fecal incontinence/constipation, and healthy controls were included.A translumbosacral anorectal magnetic stimulation test was performed by using an anorectal probe with 4 ring electrodes and magnetic coil, and by stimulating bilateral lumbar and sacral plexuses, uses and recording 8 motor-evoked potentials at anal and rectal sites.The prevalence of lumbar and/or sacral neuropathy was examined. Secondary outcomes were correlation of neuropathy with anorectal sensorimotor function(s) and morphological changes.We evaluated 220 patients: 144 with fecal incontinence, 76 with mixed fecal incontinence/constipation, and 31 healthy controls. All 8 lumbar and sacral motor-evoked potential latencies were significantly prolonged (p0.01) in fecal incontinence and mixed fecal incontinence/constipation groups compared with controls. Neuropathy was patchy and involved 4.0 (3.0) (median (interquartile range)) sites. Lumbar neuropathy was seen in 29% to 65% of the patients in the fecal incontinence group and 22% to 61% of the patients in the mixed fecal incontinence/constipation group, and sacral neuropathy was seen in 24% to 64% and 29% to 61% of these patients. Anal neuropathy was significantly more (p0.001) prevalent than rectal neuropathy in both groups. There was no correlation between motor-evoked potential latencies and anal sphincter pressures, rectal sensation, or anal sphincter defects.No comparative analysis with electromyography was performed.Lumbar or sacral plexus neuropathy was detected in 40% to 75% of patients with fecal incontinence with a 2-fold greater prevalence at the anal region than the rectum. Lumbosacral neuropathy appears to be an independent mechanism in the pathogenesis of fecal incontinence, unassociated with other sensorimotor dysfunctions. Translumbosacral anorectal magnetic stimulation has a high yield and is a safe and clinically useful neurophysiological test. See Video Abstract at http://links.lww.com/DCR/B728.ANTECEDENTES:La neuropatía puede causar incontinencia fecal y una combinación de incontinencia fe-cal/estreñimiento, pero su prevalencia no está clara, en parte debido a la falta de pruebas comple-tas de inervación espino-anorrectal.OBJETIVO:Desarrollar y determinar la utilidad clínica de una nueva prueba, estimulación magnética trans-lumbosacral anorrectal para la incontinencia fecal.DISEÑO:Estudio de cohorte observacional del 2012 al 2018.ENTORNO CLINICO:Centro de referencia terciario.PACIENTES:Pacientes con incontinencia fecal, combinación de incontinencia fecal/estreñimiento y controles sanos.INTERVENCIONES:Se realizó una prueba de estimulación magnética translumbosacral anorrectal utilizando una sonda anorrectal con 4 electrodos anulares y bobina magnética, y estimulando los plexos lumbares y sacros bilaterales y registrando ocho potenciales evocados motores las regiones anal y rectal.PRINCIPALES MEDIDAS DE RESULTADO:Se examinó la prevalencia de neuropatía lumbar y/o sacra. Los resultados secundarios fueron la correlación de la neuropatía con las funciones sensitivomotoras anorrectales y cambios morfológi-cos.RESULTADOS:Evaluamos 220 pacientes, 144 con incontinencia fecal, 76 con combinación de incontinencia fe-cal/estreñimiento y 31 sujetos sanos. Las ocho latencias de los potenciales evocadas motoras lum-bares y sacras se prolongaron significativamente (p0,01) en la incontinencia fecal y el grupo mixto en comparación con los controles. La neuropatía fue irregular y afectaba 4,0 (3,0) (mediana (rango intercuartílico) sitios. Se observó neuropatía lumbar en 29-65% en la incontinencia fecal y 22-61% en el grupo mixto, y neuropatía sacra en 24-64% y 29-61 % de pacientes respectivamen-te. La neuropatía anal fue significativamente más prevalente (p0,001) que la rectal en ambos grupos. No hubo correlación entre las latencias de los potenciales evocadas motoras y las presio-nes del esfínter anal, la sensación rectal o los defectos del esfínter anal.LIMITACIONES:Sin análisis comparativo con electromiografía.CONCLUSIÓNES:Se detectó neuropatía del plexo lumbar o sacro en el 40-75% de los pacientes con incontinencia fecal con una prevalencia dos veces mayor en la región anal que en el recto. La neuropatía lumbo-sacra parece ser un mecanismo independiente en la patogenia de la incontinencia fecal, no asocia-do con otras disfunciones sensitivomotoras. La estimulación magnética translumbosacral anorrec-tal tiene un alto rendimiento, es una prueba neurofisiológica segura y clínicamente útil. Consulte Video Resumen en http://links.lww.com/DCR/B728.

Background Anorectal malformations (ARM) represent a wide spectrum of defects. Caudal and genitourinary malformations can associate with anorectal malformations. Genetic factors may play role in the development of anorectal malformations. Perineal masses like sacrococcygeal teratoma, rectal prolapse, or duplication cysts were reported before, but their association with perineal hamartoma and anal atresia is extremely rare. Case presentation Here, we report an 11-month-old female infant. She had 551 kb duplication at 7p12.3 with perineal hamartoma and anal atresia consisting a cystic lesion with a diameter of 4 mm at the filum terminale (L2 vertebra) on lumbar magnetic resonance imaging (MRI) in neonatal period. She presented with hypotonia. She had anorectal anomaly and external perineal mass bulging from left major labium extending across anal region with imperforate anus. There was 1 × 1 cm polyp-like protrusion on it. She was operated in neonatal period. Genetic laboratory investigations showed karyotype 46, XX. The microduplication of the chromosome 7p12.3 was detected by microarray analysis. There were not any significant homozygous or heterozygous variants determined by whole-exome sequencing. Conclusions To the best of our knowledge, this is the first report of a patient with a microduplication of the chromosome 7p12.3, and second case with perineal hamartoma and imperforate anus. Clinicians should pay attention to microdeletions and microduplications while giving genetic counseling to patients with urogenital and anorectal abnormalities.

Purpose of the study: to conduct a morphological study of experimental material to assess the features of wound healing in the anal sphincter area when using the domestic drug “Heprocel” as a hemostatic agent. Material and methods. The study was carried out in the Department of experimental surgery and the department of pathological anatomy of the Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov. The state of experimental models of wounds with the application of a hemostatic agent in the form of a gel was studied. The experiments were carried out on 72 white male rats weighing 210-250 g. Two series of 36 animals each were produced. All animals were divided into groups: norm - experiment in the absence of drug hypocoagulation; control - an experiment with intravenous heparin to achieve drug hypocoagulation; experience - an experiment with intravenous administration of heparin to achieve drug hypocoagulation using an application on a model of a skin wound and a dissected anal sphincter of the hemostatic agent "Heprocel". Results. Morphological differences in the process of wound healing were most pronounced after 3 days of the study. In the control group of animals with hemostasis using an electrocoagulator, necrotic and exudative processes of inflammation in the stratified squamous epithelium and mucous membrane of the glands in the anal region were evident. In the experimental group, on the 3-5th day of the experiment, the proliferative process of inflammation predominated morphologically. A special feature is that the hemostatic gel is absorbed into the wound, forming a thin uniform layer. On the 10th day of the experiment, the above difference became more obvious. In the control group, chaotic squamous epithelial cells and fibroblasts were formed. The fibrin-necrotic layer is preserved. Focal infiltration of macrophages-lymphocytes was observed. In the experimental group, the intestinal layers began to change. In the area of the surgical incision, the hemostatic layer is preserved; in this area, the growth of thin fibrous connective tissue is observed. Differentiation and transformation of cells led to the regeneration of the epithelial layer and parakeratosis of the flat cell. Signs of complete remodeling were evident over a long period of time, such as 14 days. Conclusion. The use of a hemostatic agent in the form of a gel provides not only an increase in the processes of local hemostasis, but a decrease in the activity of inflammatory reactions and infection, as well as the risk of developing post-traumatic cicatricial deformity of the anus.

Anal Fissure is one of the significant causes of pain in the anal region. The two primary signs of this disease are pain and bleeding, and pain is often unbearable. In males, anal fissure typically occurs in the midline posterior- 90 %, and 10 % midline anterior. Subsequently, female fissures on the midline anteriorly are significantly more frequent than posteriorly (60:40). In contemporary sciences, Parikartika can be correlated with Fissure in Ano. The objective of the prospective study is to find the effectiveness of Chakramarda Ghrita & GoGhrita in the management of Parikartika. The present study is designed as a randomized, single-blind parallel in which 30 patients will be enrolled. Ghrita will be applied for local application twice a day. Assessment will be done 0th, 7th day, 14thday, and 28th day. The changes are expected to be observed in subjective parameters such as pain bleeding per rectum with itching as well as with objective parameters such as Parikartika Healing and tenderness. The study is expecting the non-surgical management of fissure in ano concerning the impact of Chakramarda Ghrita & GoGhrita. The research is expecting to be baseline and benchmark of the prospective studies in Parikartika.

Bhagandara is one of the commonest diseases which occur in anorectal region. Acharya Sushruta had described this disease in Ashtamahagada that means disease difficult to cure. It starts as deep rooted Pidika around the Guda within two Angula or finger circumference and form into a track with an external opening in the skin of perianal region and an internal opening in the mucosa of anal canal or rectum lined by unhealthy granulation tissue and fibrous tissue which in modern science can be correlated to Fistula-in-ano. As the recurrence rate of fistula in ano is high after modern treatment. To overcome these difficulties, the concept of Ksharsutra mentioned in the classics is very beneficial from the treatment point of view. So, the Guggulu (Commiphora mukul) based Ksharsutra therapy along with oral Ayurvedic formulations is taken to prove its efficacy in treating Bhagandara. Here a case report of a 32 year old, male patient having history of Bhagandara (Fistula-in-ano) since last 2 years is discussed. He had complaints of left gluteal swelling, pain, pus discharge from perianal region and itching around anal region. For which he took allopathic treatment and got no relief, finally patient came to our hospital for better Ayurvedic management. He was treated with Guggulu based Ksharsutra therapy along with oral medication of Saptavinshati Gugglu vati 500 mg with water twice daily. Lastly, he got treated in 60 days and follow up of the patient was maintained up to 6 months where no complication was reported. It was proved that Ksharsutra application in combination with oral Ayurvedic medication worked effectively. This case report will help and enlighten the budding young scholars working in this area.

Despite their benefit for detecting primary tumors, data for normal 18F-fluoro-2-deoxy-d-glucose (FDG) uptake in the anal canal are insufficient. Here we used positron emission tomography–computed tomography (PET/CT) to determine the uptake of FDG in the normal adult anal canal (AC) and to evaluate its clinical significance compared with that of anal cancer. We conducted a retrospective study of–PET/CT images in the anal region, of 201 consecutive patients without symptoms or pathology taken from January 2015 to August 2019, after excluding two patients (one each with Crohn’s disease and hemorrhoid). These patients were included in the normal group, and data of eight patients with anal cancer were collected from January 2011 to August 2019 for comparison. FDG uptake was quantitatively evaluated (compared with the maximum standardized uptake value [SUVmax] to the SUVmax values of liver and distal rectum) and qualitatively (compared with background) in early and delayed phases. Normal grade 3 uptake was qualitatively defined as FDG uptake higher than the surrounding muscles. In the normal group, mean anal canal SUVmax of early phase was: 2.26 (range 1.00–6.30), and delayed phase: 2.52 (range 1.00–8.80). Their ratios to liver SUVmax were early: 0.74 (range 0.24–2.25), and delayed: 0.81 (range 0.23–2.32); ratios to rectal SUVmax were early: 0.87 (range 0.30–1.89), and delayed: 0.90 (range 0.30–1.27). Qualitatively, 25 patients (15.4%) had normal grade 3 uptake during the early and delayed phases. In contrast, qualitative data showed that all patients with anal cancer exhibited high FDG uptake in the anal canal. The mean early- and delayed-phase values of SUVmax of the anal canal and anal cancer group were 11.09 (range 5.40–17.73) and 14.23 (range 6.70–22.85), respectively. There was a significant difference between the mean-early and -delayed anal SUVmax values of the normal grade 3 and anal cancer groups. Furthermore, the ratios to liver SUVmax were significantly different between the two groups. PET/CT scans occasionally showed high FDG uptake in the anal canal of healthy adults. Comparing the SUVmax values of liver FDG uptake may help differentiate between normal tissue and anal cancer.

Haemorrhoid is one of the most common anorectal complaints1,2 reported in anorectal clinics with estimated prevalence of 4.4% in United States and 13–36% in the United Kingdom.3 It is one of the oldest ills known to mankind with accounts available in oldest literature like Atharwaveda (1500 BCE)4 from India and Egyptian Papyrus (1700BCE)5 from the west. Haemorrhoids are actually the vascular cushions that provide a physiological hermetic seal in the closure mechanism of anal canal and helps in maintenance of continence.6 Faulty dietary and toilet habits may cause the pathological enlargement of these cushions which create misery to the patient by producing bleeding, discomfort, prolapse and sometimes pain in the anorectal region. A modification in diet, lifestyle and defecation habits can alleviate the symptoms in many patients. For the rest, various surgical methods like haemorrhoidectomy, stapled haemorrhoidopexy etc. and the office procedures like rubber band ligation, sclerotherapy, photocoagulation, cryosurgery etc. are available with each having its own merits and limitations compared to other. Though haemorrhoidectomy is still considered as the ‘gold standard’ treatment for haemorrhoids,7 office treatments for symptomatic haemorrhoids are increasing8 over the last few decades. Rubber Band Ligation (RBL), as advocated by Barron,9 is one of the safe, simple, cost-effective and the most widely used office procedure by the surgeons which eliminate the pile mass by ischemic necrosis and promote submucosal fibrosis with subsequent fixation of anal epithelium to the underlying sphincter.10 In traditional Indian medicine i.e. Ayurveda, the term arsha is used to describe an abnormal fleshy growth originating in the anal region due to improper diet, lifestyle and defecation habits.11 By definition, the term arsha may broadly include sentinel tags, hypertrophied papillae, polyps and external as well as internal piles; however, to be very specific, haemorrhoidal disease may be corresponded with raktarsha (rakta means ‘blood’ and arsha means ‘fleshy mass’), a variety of arsha described in ancient texts. The management strategies for haemorrhoids include four modalities of treatments viz. medicinal treatment, chemical cauterization, thermal cauterization and surgical excision.12 While medical management is primarily advocated for uncomplicated haemorrhoids and focusses upon improvement of digestion, easy evacuation and correction of bowel habits; large and complicated piles are advised to be treated with thermal cauterization or excised surgically. Chemical cauterization is a form of parasurgical measure which is employed by local application of a caustic material, pratisaraneeya kshara (PK; pratisaraneeya means ‘to be applied locally’, kshara means ‘alkaline caustics’) in internal haemorrhoids. It is prepared from the ashes of medicinal plants by a special technique of preparation with addition of marine shells13 and, on application, brings about necrosis in the pile mass resulting into an ulcer which heals by fibrosis.14 Local application of PK, also known as kshara-karma, is one of the most widely practiced outpatient treatments for internal haemorrhoids by the Ayurveda surgeons in India. Thus, both RBL and local application of PK have a similar mode of action and are the office procedures of choice for internal haemorrhoids among the modern and Ayurveda surgeons respectively. So, the present study was designed to compare the efficacy of these two techniques in a prospective randomized trial.

Background: Anal fissure is the most common painful condition of anal region characterised by vertical ulcers affecting distal end of anal canal. The main aim of this study is comparing 2 % diltiazem and lateral internal sphincterotomy in the treatment of chronic anal fissure.Materials and Methods: The Study was conducted as a clinical trial in Sree Mookambika institute of medical sciences, Kulasekharam from May 2020 to November 2020.100 patients diagnosed with chronic fissure in ano on the basis of history of painful defecation with or without per rectal bleeding for more than 6 weeks and per rectal examination were enrolled in the study after obtaining an informed written consent from them. Results has been detailed in both descripted and statistical point of view and simplified in understandable format.Results: In 89.36% of patients in diltiazem group and 100% of patients in lateral internal sphincterotomy group fissure healed completely between 4-8 weeks. In the diltiazem group pain relief was good. 42 patients (89.4%) had pain relief at the end of 14 weeks. 5 patients (10.6%) had no pain relief. But pain relief in lateral internal sphincterotomy group was excellent with 100% patients having complete pain relief by 8 weeks’ time. Mild headache was experienced with diltiazem by 3(6.4%) patients.1 patient (2.1%) complained of flatus incontinence with lateral internal sphincterotomy.Conclusion: We conclude that lateral internal sphincterotomy is the gold standard treatment of chronic fissure in ano but chemical sphincterotomy using 2% diltiazem gel can be considered as a good second line treatment option in those unfit for surgery or for those not willing for surgery.

Background and Aims Chronic perineal pains is a painful condition. In this study, we aimed to assess the effect the ultrasound associated to the fluoroscopy for improve the effectiveness and the safety of the radiofrequency on the ganglion impar in the patient with perianal pain1, who did not respond to standard drug therapies2 Methods The case was a 79-year-old woman with history of continuous stabbing pain in the anal region. At her first visit, the VAS was 9/10. The patient was in the prone position on the operating table. After disinfection in the region of the sacral, a sterile echographic linear probe was placed transversely on the lower portion of the sacred until the identification of the sacral cornets. Then, the probe is rotated in a longitudinal position until the identification of the sacrococcygea joint.Under constant ultrasound guidance and fluoroscopy, a 22 G 100 mm radiofrequency needle was introduced in the precoccigeo space near the ganglion impar. The position of the needle tip was confirmed by injecting 1 mL of radiopaque dye in the retroperitoneal space.Then, a thermocouple connected to a radiofrequency generator was inserted to reproduce the patient‘s paresthesia via sensitive stimulation, 0.4–0.5 mV. The radiofrequency was performed at 90°C for 90 seconds. Results At the end of the procedure the patient reported VAS 0. Conclusions The result suggests that ultrasound guided combined with fluoroscopy enhances the safety and accuracy of radiofrequency on the ganglion impar. Furthermore, it significantly reduces radiation exposure for both patients and operator.

Perianal abscess often encountered in clinical practice, has a chance of recurrence and fistula formation if not treated properly. The system of modern medicine treats the condition with incision and drainage. This case report is of a 47-year-old male presenting with pain and swelling in the anal region. The patient was diagnosed by ultrasonography (USG) perineum as a recurrent perianal abscess in the right perianal region, who formed a fistulous tract, but who improved with homeopathic treatment, as documented with serial photographs and USG. It highlighted the scope of successful management without surgical procedures.

Background Coronavirus disease 2019 (COVID-19) has a broad spectrum from respiratory and nasopharyngeal symptoms, cerebrovascular diseases, impaired consciousness, and skeletal muscle injury. Emerging evidence has indicated the neural spread of this novel coronavirus. Restless legs syndrome (RLS) is a common neurological, sensorimotor disorder, but highly under diagnosis disorder. Restless anal syndrome as restless legs syndrome variant associated with COVID-19 has been previously not published. We report a case presenting with restless anal syndrome following COVID-19. Case presentation Although a 77-year-old male with COVID-19 improved to normal respiratory function 21 days after admission and treatment of favipiravir 200 mg per day for 14 days and dexamethasone 6.6 mg per day for 5 days, the insomnia and anxiety symptoms remained. Several weeks after discharge, he gradually began to experience restless, deep anal discomfort, approximately 10 cm from the perineal region. The following features were observed in the anal region; urge to move is essential, with worsening with rest, improvement with exercise, and worsening at evening. Colonoscopy revealed internal haemorrhoids without other rectal lesions. Neurological findings including deep tendon reflex, perineum loss of sensory and spinal cord injury, revealed no abnormalities. Diabetes militias, kidney dysfunction and iron deficiency status were not confirmed. Family history of RLS and periodic limb movements were not observed. Clonazepam at 1.5 mg per day resulted in the alleviation restless anal discomfort. Conclusions We reported a case presenting with restless anal syndrome following affection of COVID-19 as restless legs syndrome variant. This case fulfilled 4 essential features of RLS, urge to move, worsening with rest, improvement with exercise, and worsening at evening. To date, no case of restless anal syndrome associated with COVID-19 has been previously published. This case report may reflect the associative impacts of COVID-19 on the neuropsychiatric state. The long-term outcomes of neuropsychiatric conditions should continue to be monitored.

Purpose Abscess or fistula of the anal region is an uncommon presentation of malignancy. Under the assumption of a benign condition, diagnostics is often delayed, resulting in advanced tumour stages at first diagnosis. Due to the case rarity, treatment guidelines for cancers of anorectal region masquerading as abscess or fistula are missing. Methods We analysed all patients presenting with an abscess or fistula of the anal region in our department between January 2004 and August 2020. The malignancies were included to our study to acquire data on clinical presentation, treatment and outcome. Furthermore, a systematic review to present adenocarcinomas and squamous cell carcinomas associated to an abscess or fistula was performed. Results 0.5% of the patients treated for an abscess or fistula of the anal region met the selection criteria. Mean time from the onset of symptoms to diagnosis of malignancy was 100 days. Histology revealed adenocarcinoma and squamous cell carcinoma each in two patients. All patients had locally advanced tumours without distant metastases, in two cases with regional lymph-node metastases. Neoadjuvant chemoradiation was applied in two patients. All patients underwent abdomino-perineal resection of the rectum. The overall outcome reveals a recurrence-free survival of 4.5 and 3 years for two patients. Further two patients died within 5 months after the primary resection. Conclusion Advanced carcinomas of the anorectal region may masquerade as abscess or fistula, cause diagnostic problems and delay oncologic treatment. However, even in these very advanced situations, surgical therapy with curative intent should be attempted.

In this case report, we aimed to describe the operative treatment of a three-day simmental breed male calf who was brought to our clinic with the complaint of stool coming from the preputium and not defecation from the anus. As a result of clinical and radiographic examinations, atresia ani and rectourethral fistula was diagnosed. Following premedication and local anesthesia, the skin and subcutaneous connective tissues were incised and the rectum was reached. The rectum, which was separated from the surrounding tissues by blunt dissection, was pulled out of the operation wound. After the closed end of the rectum was opened, the rectum part with a fistula hole opening into the urethra was extirpated. After the extirpation procedure, anus was created by suturing to the subcutaneous connective tissue and skin in the rectum anal region. Postoperative parenteral antibiotic administration and wound care with antiseptic warm water were performed for 7 days. Skin sutures were removed 10 days later. In the interviews with the owner for 6 months postoperatively, it was detected that the calf has any complication., Bu olgu sunumunda prepisyumundan dışkı geldiği ve anüsten defekasyon yapamadığı şikâyetiyle kliniğimize getirilen üç günlük simental ırkı erkek bir buzağının operatif tedavisinin tanımlanması amaçlandı. Yapılan klinik ve radyografik muayeneler sonucunda atresia ani ve rektoüretral fistül tanısı konuldu. Premedikasyon ve lokal anestezi uygulamasını takiben deri ve derialtı bağ dokuları ensize edilerek rektuma ulaşıldı. Çevre dokulardan küt diseksiyon ile ayrılan rektum operasyon yarasından dışarı çekildi. Rektumun kapalı olan uç kısmı açıldıktan sonra üretraya açılan fistül deliği bulunan rektum parçası ekstirpe edildi. Ekstirpasyon işlemi sonrası rektum anal bölgedeki derialtı bağ doku ve deriye dikilerek anüs oluşturuldu. Postoperatif olarak 7 gün boyunca parenteral antibiyotik uygulaması ve ılık antiseptikli sularla yara bakımı gerçekleştirildi. Deri dikişleri 10 gün sonra alındı. Operasyon sonrası 6 ay boyunca hasta sahibi ile yapılan görüşmelerde olguda herhangi bir komplikasyon bulunmadığı tespit edildi.

Anal sphincter spasm contributes to the delay in surgical wound healing after hemorrhoidectomy. A prospective, experimental, randomized, double-blind trial was conducted on two groups of patients that underwent closed hemorrhoidectomy. There were 26 patients in each group. Group A received topical diltiazem in the anal region three times a day. Group B received a placebo. Cicatrization time was documented for 6 weeks through digital photography. Mean healing time for the group treated with diltiazem was 3.19 weeks (22.33 ± 0.884 days) and 3.92 weeks (27.44 ± 1.130 days) for the control group (p = 0.012 95% CI). At week three, the wounds in 73.07% of the patients in the diltiazem group had healed, compared with 46.15% of the patients in the control group. Resumen: El espasmo del esfínter anal contribuye al retardo en la cicatrización de las heridas quirúrgicas después de una hemorroidectomía. Se realizó un estudio aleatorizado, prospectivo, experimental, doble ciego, de dos grupos de pacientes en los que se efectuó hemorroidectomía con técnica cerrada. Cada grupo incluyó 26 pacientes; el grupo A recibió diltiazem tópico en la región anal 3 veces al día, y el grupo B recibió un placebo. Se documentó el tiempo de cicatrización, mediante fotografía digital, durante 6 semanas. El promedio del tiempo de cicatrización para el grupo tratado con diltiazem fue de 3.19 semanas (22.33 ± 0.884 días); en tanto que en el grupo control fue de 3.92 semanas (27.44 ± 1.130 días) (p = 0.012 IC 95%). A la tercera semana, el 73.07% de los pacientes del grupo tratado con diltiazem habían cicatrizado, en comparación con el 46.15% de los pacientes del grupo control. Keywords: Diltiazem, Cicatrization, Post-hemorrhoidectomy cicatrization, Palabras clave: Diltiazem, Cicatrización, Cicatrización posthemorroidectomía

The history of association between HPV and cancer, risk factors, pathogenesis, diagnostics, treatment and prophylaxis of anal intraelithelial neoplasia (AIN) and squamous-cell anal cancer are discussed in this article. Although these conditions are rare, they may become some of the main health hazards in certain groups of patients, such as HIV-infected patients, patients with history of other HPV-related malignancies, patients practicing anal sexual intercourse and patients receiving systemic immunosuppressive therapy. A collaboration of different specialists is necessary in order to develop effective prophylactic measures for HPV-associated malignancies of anal region. There are no estabilished methods for AIN treatment. The use of ointments and local destruction are the most researched treatment methods. Vaccination is already developed as a prophylactic measure. However, a more thorogh research of HPV types in russian population is necessary prior to its wide implementation. Preliminary data favors the use of polivalent vaccines in russian population.

Background - Anal Fissure is one of the major causes for pain at anal region. The two primary signs ofthis disease are pain and bleeding, and pain is often unbearable. In males anal fissure typically occursin the midline posterior- 90 %, and 10 % midline anterior. Subsequently, female fissures on the midlineanteriorly are significantly more frequent than posteriorly (60:40). In contemporary sciences Parikartikacan be correlated with Fissure in Ano. Objective- The objective of the prospective study is to find theefficacy of Palashgudavarti & Diclofenac Sodium Suppository in the management of Acute Fissure inano(Parikartika).Material & Method: The present study is designed as a Randomized single blind parallelin which 60 patients will be enrolled. Varti will be applied for local application once a day. Assessment willbe done 0th, 7th day, 14thday, and 28th day. Results: The changes are expected to be observed in subjectiveparameters such as pain bleeding per rectum with itching as well as with objective parameters such asParikartika Healing. Conclusion: The study is expecting the nonsurgical management of fissure in ano withrespect to the impact of Palashgudavarti & Diclofenac Sodium Suppository. The research is expecting to bebaseline and benchmark of the prospective studies in Acute Fissure in ano (Parikartika).

Background : Calcinosis cutis is an uncommon dermatopathy characterized by the deposition of minerals in the skin, usually involving collagen and elastic fibers in the dermis. Usually, it results from dystrophic calcification and can be generalized or focal. The dermatopathy may be primary or secondary to certain disorders, especially chronic proliferative otitis, foreign body reactions, hyperadrenocorticism (HAC) and less frequently percutaneous penetration of calcium-rich products. The aim of this report is to describe a presentation of calcinosis cutis affecting the skin of the back, internal face of hind limbs and anal region of a 9-year-old bitch. Case : A 9-year-old, non-defined breed, bitch, ovariohysterectomized, weighing 9.45 kg, was attended at the Dermatological Service of companion animals at the Veterinary Hospital of the Federal University of Jatai (UFJ). The animal came in with the complaint of extensive dorsal alopecia, covered by firm lesions, with a 3-month evolution, additionally to polyuria and polydipsia. After physical examination, alopecic areas of great extension were confirmed on the dorsum, on the internal surface of the hind limbs and in the anal region. Also, an exudative and painful lesion located on the back was detected, plus loss of elasticity of the ventral abdomen skin and visible abdominal vessels. The screening tests showed a marked increase in the alanine aminotransferase enzyme (ALT), alkaline phosphatase (ALP) and total cholesterol. The specific urinary density was decreased. On the ultrasound examination, hepatomegaly and an increase in the caudal pole of the left adrenal were detected. Based on these findings, calcinosis cutis secondary to spontaneous hyperadrenocorticism (HAC) was suspected. For confirmation, skin biopsy and low dose dexamethasone suppression test (LDDS) were performed. LDDS test showed no reduction of serum cortisol after 8 h of dexamethasone dose administration and histopathological evaluation revealed multiple foci of calcinosis characterized by the deposition of basophilic material on the pre-existing collagen fibers, plus areas with pyogranulomatous inflammatory reaction and peripheral fibrosis with transepidermal elimination of minerals. Thus, trilostane and intense hydration of skin plaques were applied as treatment. Discussion : The dermatological alterations were compatible with those described in the consulted literature, with remarkable yellow-brown, firm, sandy-looking plaques, located on the back, internal face of hind limbs and anal region, possibly related to HAC later confirmed by LDDS test and biopsy. The management of the underlying disease and possible secondary bacterial infections are the basis of treatment. Therefore, the patient was treated with trilostane, antibiotic therapy and intensive hydration of the mineralized plaques resulting in a satisfactory involution of the clinical signs. Even though there are reports of calcinosis cutis on the dorsum, in the consulted literature there was no evidence of dorsum large extension lesion due to HAC as in this case report, but secondary to exogenous corticosteroid treatment, systemic blastomycosis and leptospirosis. In this case report, the affected thorax portion was the dorsum, differently from a study that pointed the ventral thorax as the affected portion. Similarly, anus and ventral part of the tail were hardly affected together with secondary inflammation and ulceration. Thus, the existent literature shows areas of calcinosis cutis in dogs in different parts of the body, but neither extensive as in the back of this reported female dog, nor widely affected as in the anal area, additionally to the internal face of hind limbs as already reported in the literature.

Parikartika is charecterised by sharp cutting pain in the anal region. In parikartika teevrashoola, bleeding is observed, equally extreme pain slimy blood discharge are seen in fissure-in-ano. To test the efficacy of thelocal application of kasisadi ghruta in managing. Classical signs and symptoms of parikartika (fissure in ano) age groups of 20 to 60 years have been recruited for the research. The trial group obtained treatment with kasisadi ghruta local application for 28 days, twice a day. Average relief observed was observed 62.5% for most symptoms shothahara, vedanasthapana, and ropana are in kasisadi ghruta. Properties because of which it helps in healing the ano fissure.

Over the past years, magnetic resonance imaging (MRI) has become a cornerstone in evaluating anal canal and adjacent tissues due to its safeness, the three-dimensional and comprehensive approach, and the high soft-tissue resolution. Several diseases arising in the anal canal can be assessed through MRI performance, including congenital conditions, benign pathologies, and malignancies. Good knowledge of the normal anatomy and MRI technical protocols is, therefore, mandatory for appropriate anal pathology evaluation. Radiologists and clinicians should be familiar with the different clinical scenarios and the anatomy of the structures involved. This pictorial review presents an overview of the diseases affecting the anal canal and the surrounding structures evaluated with dedicated MRI protocol.

To evaluate the mechanical properties of the tissues and muscles in the anal region with the shearwave elastography for anal fissure etiology.Descriptive study.Adana City Training and Research Hospital, Turkey, from March2019 to March 2020.In this study, 30 patients (fissure group), who were diagnosed with anal fissure in the outpatient clinic; and 20 patients (control group), who did not have any problem in anal examination were included. The anorectal tissues and muscles mechanical properties(elasticity,compliance and stiffness) were compared with the shear wave elastography values.Fissure area,internal anal sphincter,external anal sphincter and levator ani muscles elastographic measurements was performed with 5-18 MHzin lithotomy position, at rest and with Valsalva maneuver.In elastographic measurement of fissure area (fissure) and normal anorectal tissue (control, AFE); control group values were significantly higher than the fissure group values (p0.001, and padj0.001, respectively). Control group valuesof internal anal sphincter in rest and Valsalva maneuver (IAS-R, and IAS-V, respectively) were significantly higher than the fissure group values (p0.001, padj0.001, and p0.001, padj0.001, respectively). There was no significant difference between the elastographic measurement values in rest and valsalva maneuver of the external anal sphincter (EAS-R and EAS-V) (p0.05). Elastographic measurement values of levator ani muscle (LAM) resting state; were significantly higher in thefissure group than the control group (p0.001, and padj0.001, respectively). Elastographic cut-off values that differentiate the fissure group from control group were found to be ≤1kPa forAFE group, ≤44 kPa forIAS-R, ≤0.4kPa forIAS-V,and11kPa for LAM,respectively. Conclusıon: In anal fissure disease, tissues mechanical properties measured by shear wave elastography showed increased tissue stiffness, which may be added to etiology of this disease. Key Words: Anal fissure, Ultrasonography, Shear wave elastography, Anal sphincter, Tissue elasticity, Tissue stiffness.

Pilonidal sinus is a disease of a midline pit situated in mid gluteal cleft at post anal region associated with hairs. Continued sitting, obesity, hairy part, family history which increases the risk of diseases. The prevalence rate in males is more (Male & Female ration 3:1) and incidence is about 26 per 100,000 population. The treatment of pilonidal sinus includes excision and primary closure, excision with reconstructed flap technique etc. In Ayurveda pilonidal sinus is correlated with Nadivrana and it can be considered under shalyaj Nadivrana and Shushruta has explained Shastrakarma with intervention of ksharsutra as one of the treatment of Nadivrana (sinus) excision. In this case study, a case of pilonidal sinus, 21yr / Male patient diagnosed and treated successfully with integrated approach i.e. partial sinus excision adjuvant to Ksharsutra therapy. Partial sinus excision followed by Ksharsutra ligation in the remaining intact tract was performed under local anaesthesia, Patient was asked to attend surgical OPD for dressing on alternate days, and Seitz bath with lukewarm water was advocated before dressing. The Ksharsutra was changed weekly for 3 sitting. To reduce pain, inflammation and control infection, Analgesic,anti-inflammatory and oral antibiotic drug were also prescribed for 5 days. Observation revealed that sinus- track cut through and healed by 4 weeks. Patient was under observation for period of one year to check for recurrence. This innovative partial sinus excision along with Ksharsutra ligation under local anesthesia, proved an effective ,time conserving and non-recurrent, minimal invasive treatment alternative for pilonidal management.

Parikartika is a Guda-gata vyadhi related to Ano rectal diseases. This disease has been explained by all acharyas in bruhatrayee. Is the nirukti of parikartika i.e. cutting type of pain observed in Guda pradesha. Parikartika is a common painful condition among Anorectal diseases which resembles with fissure in ano. This Is a case report of 33yr male patient with complaints of Guda Pradesh Daha (Burning sensation at anal region), Sarakta mala pravrutti (stool mixed with blood), Malavasthambha (Constipation) since last 4 days. He was treated with Yashtimadhu Ghruta Matra Basti for 7days.He got significant positive relief within 7 days.

If tumours arise in special locations such as around the eyes, mouth or in the genital area, patients and physicians are challenged by the need for complete removal of the tumour with safety margins and high demands on function and aesthetic aspects. Treatment should be performed by specialized physicians including ophthalmologists, head and neck surgeons, surgical, medical and radiation oncologists. The first-line treatment for most cutaneous malignancies is surgical excision; however, in several situations, such as well-differentiated cutaneous squamous cell carcinomas (cSCC) in the periocular or anal region, radiotherapy is a very reasonable and sometimes treatment of first choice, especially in patients with advanced age. In periocular SCC, radiotherapy with superficial x-ray combined with eye shielding, while in anal SCC, radiotherapy combined with chemotherapy is recommended. However, after failure of local treatment options including surgery and radiotherapy, systemic medications are indicated in order to achieve tumour control or cure. Systemic therapies include immunotherapy, targeted therapy or chemotherapy. Preventive strategies are based on UV protection in facial, and vaccination in HPV associated anogenital SCCs.

The review examines a role of HPV in the development of pre-cancer and cancer of the anogenital region. It presents the current data on the incidence of cervical (CIN) and anal intraepithelial neoplasia (AIN), the HPV infection of the anal region in women at risk (CIN, VIN, VaIN). Methods for the diagnosis of HPV-associated diseases of the anogenital region are considered. The article reviews the literature on the importance of AIN screening development in patients with CIN, VIN, VaIN. It also provides the results of own studies of HPV infection of the anal region in patients with cervical neoplasias, data on the HPV trophicity to the epithelium of the cervical canal and the anal region. Type 16 HPV is the dominant type of HPV in patients with CIN in the cervical canal and in the anus. HPV-associated cervical diseases, in particular CIN, create a risk of infection and development of HPV-associated diseases of the anal region, including AIN. A quadrivalent HPV vaccine is now available in Russia. Although initially created and used to protect against injuries to the cervix caused by HPV, it should also be considered for the prevention of other types of HPV-associated anogenital pre-cancer and cancer.

Cloacogenic carcinoma is a rare tumor originating from epithelium of the anal transition zone of embryonic residuals. It accounts for only 2%–3% of all neoplasm arising in the anorectal canal and has clinical and morphological characteristics that distinguish them from the ordinary varieties of adenocarcinoma and squamous cell carcinoma of the anorectum. We report here a case of a middle aged male who presented to us with history of altered bowel habits, pain during defecation, passage of fresh blood in stools and pruritus in anal region and on examination there was an ulcerative growth in the anal canal. The diagnosis of basaloid variety of cloacogenic carcinoma was made upon biopsy and histopathological examination. Patient was put on chemoradiation and responded well with complete disappearance of growth macroscopically and clinically but was then lost in follow-up.Owing to the paucity of published literature on this rare malignant tumor this case is being reported here.

Anal fistula, or fistula-in-ano, is a condition involving the anal region that is common yet debilitating. Surgery is the mainstay of treatment for an anal fistula and the chances of recurrence are quite high even after corrective surgical procedures. The risk factors for recurrence can be broadly classified into four categories: 1) risk factors related to the fundamental anatomy of the fistula and presence of comorbidities, 2) lack of proper preoperative assessment of the fistula, which includes failure to recognize the internal opening and overall structure of the fistula and not supplementing the proctologic examination with sufficient imaging, 3) intraoperative loopholes that include improper procedure selection, inexperience of the surgeon, and failure to get rid of the entire tract along with its ramifications, and 4) lack of proper postoperative care in the early and late periods following the surgery. The aim of this paper, therefore, is to highlight the factors that could increase the risk of recurrence in different types of anal fistulae. Once surgeons know these risk factors, they can anticipate any complication and detect recurrence early.

Background: Fournier's gangrene (FG) is a synergistic necrotizing fasciitis that involves the genitalia, perineum, or anal region and can be life threatening and generally necessitates urgent surgical intervention. It often causes scrotal defects that require reconstruction after surgical debridement. The reconstruction of these serious scrotal defects poses certain challenges for surgeons. In this study, reconstruction of scrotal defects caused by FG with medial circumflex femoral artery perforator (MCFAP) flap evaluated. Patients and Methods: Seventeen patients with FG reconstructed using a MCFAP flap, admitted to our hospital between February 2003 and March 2017, are included in this study. Reconstruction with MCFAP flap results, mean debridement number, comorbid diseases, and length of hospital stay are analyzed together. Patients with FG reconstructed using techniques other than MCFAP were not included in this study. Results: Eighteen MCFAP flaps were performed in 17 patients. The mean duration of operation was 2 h 55 min. Diabetes mellitus was the most common comorbid disease. The mean days of hospital stay were 19.9. Total flap loss was not seen in 17 patients. Donor area of the flap is closed primarily, by V-Y advancement flaps or by split-thickness skin grafts. Acceptable cosmetic results and scrotal contours were obtained in all patients. No major complications were observed. Conclusions: Using a MCFAP flap, a method that has minimal donor site morbidity, requires single session surgery, provides good skin quality and color similar to the scrotum, is an easy-to-perform process, proving to be a reliable flap for scrotal reconstruction.

A 44-year-old male patient diagnosed with Anal Fissure and Stage II Hemorrhoids in 2013. He has been suffering ever since, avoiding surgery, using local analgesic and anti-hemorrhoidal crèmes. Physical examination in February 2017, showed a chronic character of his problem and hemorrhoids to have progressed to Stage III. The common shared decision between patient and surgeon was to proceed with a combination of a LIS for the Anal Fissure and an ELITE minimal invasive procedure for hemorrhoids. The operating time of the dual procedure was short and the patient witnessed a remarkable, painless post-op rehab period. The results of the ELITE technique using a diode laser for treating hemorrhoidal nodules are very promising. In the hands of an experienced surgeon the technique is applicable to be used in combination with other procedures in order to treat several problems in the anal region at the same time.

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

Perianal giant condylomata acuminate (GCA) is a rare clinical condition associated with low-risk Human papillomavirus (HPV) type 6 and 11 infections. Human Immunodeficiency Virus (HIV) infection is one of the risk factors for GCA, that can increase the condylomata acuminate incidence and spread caused by HPV. A 28-year-old man came with a cauliflower-like mass complaint in his perianal and anal since 2 months ago. The patient did not complain of pain or itching on the mass but often bled when defecating. The patient is a male who has sex with men (MSM) and often changes partners. He has been diagnosed with HIV since 11 months ago and regularly taking anti-retroviral drugs, Efavirenz 600 mg daily. He was also diagnosed having lung tuberculosis at the same time, got 6 months treatment and was declared cured. The venereological examination of the perianal and anal region revealed erythematous and grayish stem-shaped vegetation and papules, verrucous surface, multiple, well defined, with 3 x 1.5 x 2 cm in size. A positive act of white examination was obtained. Blood tests revealed CD+4 230 cells /μL. Polymerase chain reaction (PCR) examination for HPV obtained HPV types 6 and 11 infections. Histopathologic examination revealed acanthosis, papillomatosis, and hyperkeratotic epidermis and koilocytotic cells. The patient was treated with electrodesiccation three times but obtained mass in anal getting bigger with a size of 6 x 3 x 3 cm. Therefore, he agreed to be referred to the surgical department with an extensive surgical excision plan. Screening of GCA using PCR is not a routine examination but PCR has high sensitivity and specificity for determining the type of HPV, is useful for determining GCA prognosis and therapy, and is recommended for malignant and possible GCA recurrence detection

Objectives This study aimed to estimate the prevalence of genital, anal and oral HPV infection in Brazil through systematic review and meta-analysis. Methods We searched EMBASE, LILACS, MEDLINE, Web of Science and SciELO from inception to December 2018. Original research articles that assessed the prevalence of genital (i.e., cervical, penile), anal and oral HPV infection in Brazil were selected in pairs by independent authors. No sex, age, HPV vaccination, language or date restrictions were applied. HPV prevalence was estimated and stratified according to risk factors population and by geographic area throughout the country. The study prevalence was pooled using a random effects model. Analysis was performed using R (version 3.5.2), packages meta version 4.9-4 and metaphor 2.0-0. This review is registered on PROSPERO under protocol number CRD42016032751. Results We identified 3,351 references. After the screening process, 139 of them were eligible for this systematic review (57,513 total participants). Prevalence of cervical HPV was 25.41% (95% CI 22.71-28.32). Additionally, prevalence was 36.21% (95% CI 23.40, 51.33) in the penile region, 25.68% (95%CI 14.64, 41.04) in the anal region, and 11.89% (95%CI 6.26, 21.43) in the oral region. Subgroup analysis showed prevalence in each anatomic site was higher in high-risk populations. Conclusion The prevalence of HPV is high in the Brazilian population and varies by population risk and anatomic body site, with lower rates in the oral cavity compared to that in the cervical, penile and anal region. Studies on HPV have primarily been developed to evaluate infection and cancer in the cervical region. There is a profound lack of HPV data in many geographic regions of Brazil and for different anatomic sites.

Severe anal region injuries are rarely seen in emergency departments, but these injuries may be associated with morbidity and mortality. This case report aims to present a patient whose anal region was injured in a sports accident. An 18-year-old male patient was admitted to the emergency room because of a knee blow to his anal region while playing football. In the anamnesis of the patient was determined pain and laceration in the anal region. The patient had no additional complaints. On physical examination of the patient; approximately 2-3 cm of laceration was observed around the patient’s anal region, extending from the anal mucosa at the 7 o’clock direction. The patient was operated by a general surgeon and discharged after 1 day of hospitalization at the general surgery service. It should not be forgotten that there may be anal region traumas during football matches, one of the common sports. People should be careful to protect themselves from physical blows that can occur when playing football.

Introduction Fibroadenomas are one of the most common benign breast lesions, however they have also been found on rare occasions elsewhere. These lesions usually arise from mammary-like glands (MLG) of the anogenital region which were first described by van der Putte. Methods This case is about a 51-year-old female who presents with symptomatic hemorrhoids and a 5 cm nodular lesion external to the anal verge. These were removed and examined histo-pathologically. Results Pathology revealed three hemorrhoidal specimens and the nodular lesion which was consistent with a fibroadenoma. Histologically, the nodular lesion demonstrated a benign process with ductal proliferation and estrogen receptors. Conclusions Fibroadenomas in anatomic locations other than the breast are very uncommon. Other sites noted in prior case reports include gallbladder, prostate, arm, eyelid and anogenital region. Most of the anogenital lesions have been found on the vulva, with only six documented cases in the anal region, making this pathology exceedingly rare.

Chemoradiotherapy is the standard treatment for anal squamous cell carcinoma (SCC). Recently?it has been reported that a combination therapy of taxane, platinum and fluoride pyrimidine is useful for SCC. A 58-year-old woman was admitted to our hospital with anal pain and constipation. Computed tomography (CT) scan revealed a 9×6 cm tumor, stenosis in the anal region, and swollen pelvic and inguinal lymph nodes. She underwent laparoscopic ileal stomatoplasty and biopsy. A diagnosis of SCC of anal canal was confirmed by histopathological examination. She received a combination therapy with docetaxel, cisplatin and S-1 (DCS), followed by radiation therapy (RT). After her chemoradiotherapy, no abnormal accumulation was observed on a positron emission tomography-computed tomography (PET-CT) scan, and she was diagnosed with metabolic complete response (CR). The 3-drug combination therapy of taxane, platinum, fluoride pyrimidine followed by RT as primary treatment may be effective in the treatment of anal SCC.

The patient was a 61-year old male on maintenance dialysis who underwent transrectal prostate biopsy due to a high PSA level. The patient started suffering from intense pain in the anal region 1 hour after the biopsy, and in 7 hours, intense lower abdominal pain and bilious vomiting developed. Progressive anemia was observed with a giant retroperitoneal hematoma which had partially extended intraperitoneally on a non-contrast CT image. These findings might have been caused by arterial bleeding which occurred during the prostate biopsy. The general condition was stable, and the symptoms were improved by blood transfusion and conservative treatments.

Many chemicals used as medical treatments can cause chemical burns as an untoward side effect. One of such chemicals is potassium permanganate. It is a caustic chemical used as a disinfectant. The most common sites of burn by potassium permanganate are exposed sites like the face and hands. Chemical burns in the perianal and anal region are rare in clinical practice and even sparser in the pediatric age group. In this article, we report a case of perianal and anal chemical burn in an 18-month-old, male child, caused by potassium permanganate crystal applied wrongly for the treatment of pinworm infestation. As a chemical burn in this region can have serious complications, it is necessary to be vigilant when using such chemicals in these cases. Early and timely management in such cases leads to good outcomes. This is the first of such cases of chemical burn caused by potassium permanganate in the anal and perianal region.

Background. Diaper rash, also known as diaper dermatitis (DD), is a very common skin condition in infants, and use of disposable diapers with breathable materials is an effective approach for the management of diaper rash. In China, new material diapers and standard diapers are currently the two most commonly used disposable diapers. This study aimed to compare the effectiveness of new material diapers versus standard diaper for the prevention of diaper rash in Chinese babies. Methods. A total of 80 eligible babies admitted to Shanghai Skin Diseases Hospital during the period from June through July, 2016, were enrolled and randomized into two groups. Babies in Group A (n=41) used the new material diapers, and babies in Group B (n=39) used standard diapers. Two weeks after the use of the diaper, the babies used the alternate product for the next 2 weeks. Skin conditions were assessed on the front and back waist, right and left buttock, pubic region, anal region, and right and left groin using a 6-point scoring system based on four parameters in 0, 2, and 4 weeks after use of the diapers. Results. There were changes of the mean skin assessment score in each of the six regions after the use of the diapers. There were significant differences, in the mean skin assessment score of the front waist in Group A between weeks 2 and 4 (P=0.006) and in Group B between weeks 0 and 2 (P=0.004), and no significant differences were detected in the mean skin assessment score of the back waist and buttock in both Group A and Group B on weeks 0, 2, and 4. A higher mean skin assessment score of the pubic region was assessed in Group A on week 4 than on week 2 (P=0.036), with a higher score seen on week 2 than on week 0 (P=0.048), while no significant differences were found in Group B among weeks 0, 2, or 4. There was a higher mean score of the anal region assessed in Group A on week 2 than on week 0 (P=0.01), while a higher mean score was found in Group B on week 2 than on weeks 0 (P=0.036) and 4 (P=0.01). In addition, a higher mean skin assessment score of the groin was detected on week 2 than on week 0 in both Group A (P=0.00001) and Group B (P=0.0001). Conclusion. The new material diaper is superior to the standard diaper for the prevention of diaper rash in Chinese babies.

In surgical approaches to the perineum in general and anal region specifically, considering the possible variations of the inferior rectal nerve is important for the surgeon. Normally, the inferior rectal nerve originates as a branch of the pudendal nerve. However, during routine dissection, a variant of the inferior rectal nerve was found where it arose directly from the third sacral nerve ventral ramus (S3). Many cases have described the inferior rectal nerve arising independently from the sacral plexus, most commonly from the fourth sacral nerve root (S4); however, few cases have reported the inferior rectal nerve arising from S3. Herein, we describe a variant of the inferior rectal nerve in which the nerve arises independently from the sacral plexus.

Context: The variation in anatomical features of sacral hiatus and the dorsal wall of sacral canal is related to its clinical application in caudal epidural anesthesia. Through the sacral hiatus, it is employed in operation in the anal region and on the external genital organs, as well as cystoscopic examination of male. Continuous caudal anesthesia is also used in obstetrics during parturition for better cervical dilatation and shortening the first stage of labor. Methods: The present study was performed on 172 (one hundred seventy two) adult human dry sacra of unknown sex. The study samples were distributed in male and female sex groups by discriminant function analysis. The study was cross sectional analytical type and was conducted in the department of Anatomy, Dhaka Medical College, Dhaka, from January 2011 to December 2011. The various landmarks of sacral hiatus were measured with the help of digital slide calipers. Results: The mean length of sacral hiatus in male and female was found 26.38±12.02 mm and 25.63±10.46 mm respectively. The mean anterior-posterior diameter of sacral hiatus at the apex was found 4.76±1.73 mm in male and 4.92±2.13 mm in female. Transverse width of the sacral hiatus at the base found 17.29±3.89 mm in male and 18.01±3.70 mm in female. Different in shape of sacral hiatus between male and female found statistically not significant. Location of apex of sacral hiatus was found highest in number at the level of 4th sacral vertebra (60.20%) and maximum location of base of the sacral hiatus was at the level of 5th sacral vertebra (91.20%). The sacral hiatus has anatomical variations and understanding of these variations may improve the success of caudal epidural anesthesia. DOI: http://dx.doi.org/10.3329/jdmc.v23i1.22690 J Dhaka Medical College, Vol. 23, No.1, April, 2014, Page 31-36

The review examined the role of HPV in anogenital diseases. There are presented modern data on the prevalence of anal intraepithelial neoplasia (AIN), HPV infection of the anal region among women at risk (cervical intraepithelial neoplasia - CIN, vulvar - VIN, vaginal - VaIN). There are considered methods of diagnosis of HPV-associated anogenital diseases. Analyzes the literature on the importance of the development of screening AIN in patientswith CIN, VIN, VaIN. There are presented data of the preliminary results of the research of HPV infection of the anal region in patients with genital neo-plasias, the data on different tropism of HPV to cervical epithelium and the epithelium of the anal region.

Anal canal accounts for 2% of all cancer and its incidence increases with age with a predominance in woman. About 80% of all primary anal canal cancers are squamous; adenocarcinoma arising from the glands or glandular ducts shows a behaviour that is similar to that of the adenocarcinoma of the rectum. Risk factors includes sexually transmitted infection with Human Papillomavirus, cigarette smoking, immunosuppression, and sexual practices. The standard treatment for anal canal is chemo - radiation with a combination of fluoropyrimidines and mitomycin or cisplatin. Salvage surgery may be necessary for residual disease after radiotherapy or chemoradiation, for locoregional relapse and/or for sequelae. In the metastatic setting a multidisciplinary approach is preferred and includes medical treatment, surgery, and RT, if appropriate. Discussing these possible options in the initial stage is of most importance to ensure the best quality of life (QoL) for patients.

In this case report; an Anatolian water buffalo calf with defecating problem since birth, was referred to the our clinic, was evaluated. Clinically no anal opening of anus was visible. There was a soft swelling under anal region which suggested us the case to be atresia ani. The animal was prepared for surgery. Following anaesthesia plus (+) shape like incision was made over the anal region, skin retracted. Greyish colour of rectum end was seen in two cm inside of the skin. Rectum was withdrawn towards anal skin and fixed. After fixation, rectal end was perforated and meconium coming up to was observed. This case, atresia ani alone was reported first time in an Anatolian water buffalo calf with case report in Turkey.

Microbacterium nematophilum is a gram positive bacterium that colonizes the Caenorhabditis elegans rectal region causing swelling and constipation. This interaction has been exploited as a model system to identify and study genes important in host–pathogen interactions and innate immunity. During attempts to inhibit the host–pathogen interaction, it became important to clarify the route of infection. Using bacteria labeled with the fluorescent dye Cy3, we show that infection is via the oral route only and that infection follows a clear pattern of ingestion, plug formation, and bump development that can be quantitatively tracked over time.

A day-old Bunaji bull calf weighing 15 kg from a herd of 59 was presented to the large animal unit of the Veterinary Teaching Hospital, Ahmadu Bello University, Zaria, with the chief complaint of inability to defecate. History revealed that the bull calf was calved 17 hours prior to presentation and had not defecated since then. On further clinical examination, it was observed that there was no anal opening and there was intermittent straining characterized by the bulging of the anal region anytime the calf strained. A diagnosis of atresia ani type II was made and was surgically managed with local infiltration of lidocaine hydrochloride to achieve local desensitization of the surgical site using a ring block. The calf recovered fully uneventfully 15 days postoperation. This report presents a classical form of a congenital anomaly of atresia ani type II and a successful surgical intervention. Keywords: Atresia ani, Bull-calf, Congenital anomaly, Surgical management, Type II

Parikartika is one of the most common disorder of ano-rectal diseases. Parikartika resembles with ‘fissure in ano’ having cutting and burning pain in guda (anus). It is most painful condition affecting the anal region. In Parikartika, the local treatment is such as ointments, Ghrita, Taila and dilatation also known. In the present clinical study the Dwiharidra Raskriya Pichu is taken as external application on fissure (Parikartika).Â

Background: Our purpose was to investigate if dysregulation of cell adhesion molecules could be linked to prognosis in squamous cell carcinomas (SCCs) of the anal region. Methods: Protein expression of desmoglein-1 (DSG1), desmocollin-1 (DSC1) and E-cadherin was studied by immunohistochemistry in a cohort of 53 anal carcinoma patients treated by radiation alone or combined with 5-fluorouracil and mitomycin C. Results: Univariate analyses identified, among others, negative membranous DSG1 staining (P=0.009), negative cytoplasmic DSC1 staining (P=0.012) and negative DSG1 (membranous)+negative DSC1 (cytoplasmic) staining (P=0.004) to be associated with improved cancer-specific survival (CSS). On multivariate analyses positive DSG1 (membranous)+DSC1 (cytoplasmic) staining (HR 6.95, P=0.044), large tumour size and lymph node metastases (HR 6.44, P=0.004) and radiation without chemotherapy (HR 6.73 P=0.004) were associated with worse CSS. On univariate analysis, improved disease-free survival was associated with negative membranous staining of DSG1 (P=0.047), and negative DSG1 (membranous)+negative DSC1 (cytoplasmic) staining (P=0.025), among others. Conclusion: Membrane negativity for DSG1 and cytoplasmic negativity for DSC1 are favourable markers for CSS in SCCs of the anal region.

Condylomata acuminata caused by human papillomavirus (HPV), a sexually transmitted virus, are rarely seen beyond the external genitalia and anal region. Here, a patient with innumerable condyloma acuminatum of the bladder is presented. Attempted surgical resection was performed and intraoperative photographs are presented.