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Three male patients who had an anal keratoacanthoma are described. Anal keratoacanthoma is a rapidly growing skin tumor that invades the dermis but remains locally and can mimic clinically and histologically a squamous-cell carcinoma.

Retained surgical sponge in the abdomen following abdominal and pelvic surgery is an uncommon condition. Here we present a case of retained surgical sponge with unusual presenting symptoms. A 27-year old female patient presented to our department with a foreign body localized in the anal region. She had a past history of a myomectomy 1 year earlier. Clinical examination and radiographic workout revealaed a sponge migrating towards the rectum. The sponge was removed under visual guidance of rectoscopy without laparotomy. The patient was discharged without complications.

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

Study Objective To determine whether warmed (body temperature) ropivacaine increases the speed of onset of sensory block of epidural anesthesia. Study Design Prospective, randomized, double-blind study. Setting University hospital. Patients 180 ASA physical status I and II patients, aged 18 to 64 years, undergoing elective anal surgery. Interventions Patients were randomly divided into 6 groups defined by ropivacaine temperature [room temperature (RT) or body temperature (BT)] and concentration (0.5%, 0.75%, or 1.0%). Measurements Sensory block was evaluated by pinprick at the T10, T12, L3, and the perianal region (S4, S5) dermatomes. pH values and adverse events were also recorded. Main Results There were no differences in baseline demographics, pH, or upper sensory level between groups. Mean onset time of T12 and L3 sensory block was significantly faster for each BT than RT ropivacaine concentration. Anal region (S4, S5) sensory block was significantly faster after BT 0.75% versus RT 0.75% ropivacaine. Conclusions Warmed ropivacaine shortens the onset of sensory block of epidural anesthesia.

Transperineal ultrasonography performed with conventional equipment and probes can be used as an important diagnostic tool in the assessment of anorectal disorders to demonstrate the anatomy of the perianal region. Advantages of this procedure include low costs and high availability, and extensive perineal scanning provides combined images including transverse, longitudinal, and oblique ultrasonographic sections. Also, it is a minimally invasive procedure without anal introduction but with particular advantages with regard to painful anorectal conditions. The aim of this chapter is to describe the technique of transperineal ultrasonography and to show normal images of the anal region.

A large variety of neoplasms are found in the anal canal and perianal region. Most are distinctly uncommon and may, therefore, pose the question of suitable therapy. For some neoplasms, the treatment of choice is clear cut, while for others it is controversial. Certainly for squamous cell carcinoma of the anal canal, there has been a major rethinking of the treatment of choice. This review highlights the types of lesions found in the anal region and the current status regarding their appropriate treatment.

This study was carried out in five full-term newborn babies and 11 patients with anorectal anomalies (five of whom had high deformity, five had intermediate, and one had low), using the modified Bielschowsky method. The following four kinds of sensory nerve ending were found: muscle spindle in the puborectalis and the external anal sphincter, Pacinian corpuscle in the plane between the internal anal sphincter and the external anal sphincter and in the presacral space, globular ending in the presacral space, and free nerve ending in the epithelium of the anal canal and in the perianal skin. It was found that there were significantly fewer muscle spindles in the puborectalis and many fewer Pacinian corpuscles and globular endings in the presacral space of high and intermediate deformities than normal. No spindle was found in the external sphincteric muscles of the deformities. On the other hand, the Pacinian corpuscles and the globular endings of high and intermediate deformities lagged behind normal in development. The densities of the nerve bundles in the subepidermis and the nerve fibers in the dermis of perineal region in high and intermediate deformities were much lower than normal, and the decrease in density corresponded to the levels of the rectal pouch. The observation showed that the agenesis of sensory nerve endings in the puborectalis and the anal region was one of the most significant pathological features in high and intermediate types of anorectal anomalies, and might be responsible for the abnormalities of the reflex of the anal sphincter and the anal sensation in such patients. The muscle spindles in the puborectalis may be only potential receptors for the reflex and sensation after surgery.

女性の肛門疾患の特徴をわれわれの施設の統計から検討した.1989年までの外来統計によると男女比の平均は1.6 : 1であるが, 次第に女性の増加傾向が見られた.肛門の3大疾患の頻度は外来, 手術例とも男性では痔核, 痔瘻, 裂肛, 女性では痔核, 裂肛, 痔瘻の順であり, それぞれの疾患の手術率に男女差はない.1987年までの4年間の手術例 (痔核 : 男684例, 女698例, 裂肛 : 男70例, 女101例, 痔瘻 : 男685例, 女161例) の検討によると, (1) 女性の痔核手術の76.5%, 裂肛手術の64.4%, 痔瘻手術の56.7%に出産の既往がある, (2) 手術となる年代には男女差がなく, 痔核, 裂肛は50代, 痔瘻は30代にピークがある, (3) 術前に便秘症状を有したものは女性に多い, (4) 女性には痔核手術例では痔核の4箇所以上の切除を必要とした切除部が多いものが15.5%と多く, 痔瘻手術例では単純なタイプの低位筋間痔瘻が全体の81.4%を占め, 裂肛では肛門ポリープの合併したものが31.7%にみられた.

O Carcinoma basocelular (CBC) é a mais freqüente das neoplasias epiteliais, localizando-se preferencialmente em áreas expostas ao sol. A ocorrência deste tumor na região perianal é extremamente rara. Neste artigo, relatamos um caso de CBC perianal. Apresentamos também uma revisão da literatura médica sobre o tema, salientando as características clínicas e histopatológicas, bem como o tratamento preconizado para esse tipo de tumor. Basal Cell Carcinoma (BCC) is the most common skin cancer. It is preferentially found in sun-exposed areas and it is extremely rare at perianal region. In this article, we report a case of perianal BCC. In addition, we present a review of the medical literature on this subject, outlining clinical and histologic characteristics of this type of tumor as well as the choices of treatment.

Primary melanoma of the anal region is a rare pathological entity and its prognosis is generally poor. The aim of this report is to demonstrate the feasibility of the sentinel lymph node (SLN) procedure with combined technique in patients with anal melanoma. We report of two cases with anal melanoma that had wide local excision of the primary lesion and was referred for further evaluation. After diagnostic metastatic work-up, SLN procedure consisted of a combination of preoperative lymphoscintigraphy with technetium-99m nanocolloid injected around the tumor, and intraoperative detection of SLN with gamma probe (combined technique) was performed. In addition, patent blue dye was injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. In the first case, SLN identified both inguinal and iliac lymph node basins, both of which were histologically negative on both frozen and paraffin sections. In the other case, SLN removed from the inguinal lymph node basin showed micrometastasis by paraffin section. In both cases SLN procedure with combined technique was performed sufficiently without significant complications. Consequently, we suggest that SLN procedure with combined technique is also a useful technique in malignant melanomas similar to other anal canal cancers.

Successful surgical intervention of atresia ani-etdistal recti with agenesis of vulva in a heifer calf is reported in this paper. The calf aging 1-day was presented with a history of swelling at the perineal region. In clinical examination, both vulval and anal openings were found absent. Initial surgical operation under sedation and local anesthesia was done to correct these abnormalities. As a result, the calf could urinate, but attempted defecation was not successful. Surgical operation was done again at the anal region to resolve this condition. Post-operatively, tetracycline spray was applied on both surgical wounds immediately after surgery, and repeated twice daily for 10 days. Amoxicillin trihydrate (at 750 mg/kg bwt) and Phenylbutazone (at 400 mg/kg bwt) were administered intramuscularly once, and the treatment was repeated on every alternate day up to 10 days of post-surgery. Finally, the calf was able to urinate and defecate normally, and the surgical wounds healed uneventfully within 14 days. http://dx.doi.org/10.5455/javar.2015.b95

basic technique of the operation and for this reason leave the same postoperative recurrences of classic operations (hemorrhoidectomy, sphincterotomy, fistulectomy or fistulotomy or sinus excision) but make easy and fast their execution. With particular regard to radiofrequency pilonidal sinus excision, we treated 30 patients during the last year. In all of them immediate postoperative pain (during the first 24 h) was mild and 19 patients achieved a complete healing with primary closure (63.3%; fig. 1 ). The patient’s satisfaction rate, measured 15 days after the operation, was high (8.5 on a VAS scale) and, after 1 year, no recurrence was recorded. Radiofrequencies are a new tool in proctology still frequently misunderstood Dear Sir, In a recent article in Digestive Surgery , Gupta [1] outlined an important issue in the field of proctology. The most important characteristic that makes radiofrequency surgery different is its cutting-coagulating ability developed through the use of radiowaves that generate a tissue temperature not exceeding 65 ° C and assimilated to a ‘cold’ cut. This is important when operating on delicate tissues such as those of the anal region because the atraumatic nature of the cut allows a dramatic reduction of tissue edema with subsequent improvement of the postoperative pain. Moreover, healing processes, by a histologic analysis, are optimal and faster than normal with fewer long-term complications. Finally, radiofrequencies do not alter the Published online: June 23, 2006

This study was designed to assess the long-term results following radiochemotherapy in patients with anal squamous-cell carcinoma and to evaluate the impact of tumor location on response, survival, and colostomy-free survival.Between 1985 and 2001, a total of 101 patients with anal carcinoma were registered for curative treatment, of whom 77 had involvement of the anal canal alone, 10 cases had extension into the perianal skin, and 14 patients had pure anal margin tumors. Small tumors of the anal margin were not included since they were treated by surgical excision only. Among the 101 patients were 74 women and 27 men with a median age of 62 (range, 26-84) years. T categories (International Union against Cancer) were T1 (15), T2 (36), T3 (34), and T4 (16). Seventy-one patients had no evidence of nodal disease, whereas 30 presented with involved regional nodes. Radiation treatment was directed to the primary tumor region and to the inguinal, perirectal, and internal iliac nodes using a three-field to four-field box technique with 10MV photons up to a total dose of 5040 cGy. Lesions greater than 5 cm received an additional boost by interstitial or external radiation depending on circumferential extension of the residual tumor. All patients were scheduled for simultaneous chemotherapy with two cycles of 5-fluorouracil at a dose of 1000 mg/m (2)/day as 120 hours of continuous intravenous infusion on Days 1 to 5 and 29 to 33 and mitomycin C at 10 mg/m (2)/day on Days 1 and 29. Median follow-up time was was 7.5 (range, 1-16) years.Overall survival and colostomy-free survival rates for patients with anal canal cancer were 75 percent and 87 percent at five years, respectively. Patients with anal margin cancer had a less favorable outcome with five-year-overall and colostomy-free survival rates of 54 percent and 69 percent, respectively. After correction for imbalance between anal canal and anal margin tumors, i.e., exclusion of T1 tumors of the anal canal, difference in overall survival remained significant (73 percent vs. 54 percent, P = 0.01). Following multivariate analysis, tumor location (anal canal vs. anal margin, P = 0.02), age (P = 0.003), and dose intensity of chemotherapy (or =75 percent vs.75 percent, P = 0.03) remained independent significant factors for overall survival. Initial tumor response at six weeks (P = 0.03) was predictive for colostomy-free survival.With colostomy-free survival rates around 85 percent, long-term treatment results for anal canal carcinoma have reached a satisfactory level. However, patients with larger lesions of the perianal skin are at high risk for locoregional recurrence and possible treatment intensification in this subgroup seems desirable.

Peri-anal rash is common and may appear macroscopically benign. In HIV-positive men, however, more serious pathology may be revealed by a biopsy. The high prevalence of human papillomavirus infection in these men predisposes them to pre-cancerous lesions of the peri-anal and anal skin. We report an unusual case of dual pathology in the anal region, which highlights the need to thoroughly investigate peri-anal symptoms in HIV-positive men.

To identify dose-volume parameters related to late rectal bleeding after radiotherapy for prostate cancer.Clinical complication data from a randomized trial were collected and linked to the individual dose-volume data. In this trial, patients with prostate cancer were treated with either conventional (with rectangular fields) or three-dimensional conformal radiotherapy to a dose of 66 Gy. Patient complaints, including rectal blood loss, were collected for 199 patients, using questionnaires. Absolute and relative dose-volume histograms (DVHs) of the rectal wall (with and without the anal region) were calculated with and without rectal filling. A proportional hazard regression (PHR) model was applied to estimate the probability of any rectal blood loss within 3 years, as a function of several DVH parameters. In a multivariable analysis, dose-volume parameters were tested together with patient- and treatment-related parameters (age, smoking, diabetes, cardiovascular disease, tumor stage, neo-adjuvant androgen deprivation, conformal vs. conventional and rectal bleeding during treatment).The estimated incidence of any and moderate/severe rectal bleeding at 3 years was 33% and 8%, respectively. Differences between the conventional and conformal technique were small and not significant. The analysis of relative DVHs of the rectal wall (with and without the anal region), showed significant (p0.01) relations between the irradiated volume and the probability of rectal blood loss within 3 years for dose levels between 25 Gy and 60 Gy. This relationship was shown in subgroups defined by dose-volume cutoff points as well as in the PHR model, in which a continuously rising risk was seen with increasing volumes. For absolute DVHs and DVHs of the rectum including filling, less or no significant results were observed. The most significant volume-effect relation (p = 0.002) was found at 60 Gy for the rectum wall excluding the anal region. The probability of rectal bleeding increased from 10% to 63% when the irradiated rectum volume at 60 Gy increased from 25% to 100%. Other factors. including age, smoking, diabetes, cardiovascular disease, tumor stage, neo-adjuvant androgen deprivation, conformal vs. conventional, rectal bleeding during treatment, rectum length. and whole rectum volume. did not have a significant effect in the multivariable analysis. When controlling for the volumes at 60 Gy, the volumes at lower dose levels (25-55 Gy) were no longer significant (p = 0.5).For any rectal bleeding within 3 years, an overall incidence of 33% was observed for patients treated to 66 Gy. For this endpoint, a volume-effect relation was found for DVH parameters of the relative rectal wall volume. This relationship appeared to be most significant for the rectum without the anal region and for the higher dose levels (50-60 Gy).

Aim Reconstruction of a stenotic anal canal and repair of a stenotic perineal colostomy using a free graft foreskin. Method The use of free graft foreskin anoplasty was described by Freeman for the treatment of mucosal prolapse in pediatric patients. The original surgical technique was modified and employed in two adult patients for the reconstruction of the anal region. Results The graft, in both cases, took well with a satisfactory functional and morphological recovery of the anal canal. Conclusion Free graft foreskin anoplasty, has proved to be an effective solution to stenosis in the anal canal following major local surgery.

Intractable perineal pain often appears in the anal region following abdominoperineal resection for the treatment of rectal cancer. In such cases, a subarachnoid block or transsacral block is generally used to control pain. However, these procedures sometimes cause complications such as dysuria or sensory paralysis of the pudendum. A new method of pain control is presented herein using absolute alcohol as a neurolytic agent to relieve localized perineal pain through a coccygeal nerve block in the anterior sacrococcygeal ligament. Five cadavers were necropsied to localize the coccygeal nerve. A loop consisting of S4, S5, and Co was found to exist in the space surrounded by the anterior surface of the coccygeal bone and the anterior sacrococcygeal ligament. Absolute alcohol was injected into this space. It is essential that the neurolytic agent remain localized in this space to avoid complications and to successfully block perineal pain. In all patients, we found that this method was extremely effective in blocking localized perineal pain without any complications.

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare tumour-like lesion, which occurs in the skin of newborns, principally of the face and neck. RMH has also been reported in unusual sites, including oral cavity, nasal

A 50-year-old man presented with recurrent tumorous lesions on the penis and the anal region. The anal lesion was histologically diagnosed as verrucous carcinoma (VC) and the penile lesions were in line with condylomata acuminata. Samples taken from tumors of both sites were human papillomavirus (HPV) DNA positive. Two of them taken from the penis and the perianal region scored HPV DNA 6 positive by using polymerase chain reaction and the Southern blot method. Treatment of both VC and condylomata acuminata consisted in surgery and adjuvant immune therapy. Neither tumor recurrence nor metastases occurred up until 6 months after therapy.

The anal region is divided into an anal canal and a perianal (skin) region or anal margin. The separation is clinically important, as will be discussed further. The boundary however is a matter of extensive discussion in the literature, adding to some confusion in the reporting of the results of treatment.

Summary Background Studies of the use of artificial urinary sphincters for faecal incontinence have led to refinement and adaptation of such sphincters to the anatomy of the anal region. We aimed to test this new device. Methods Six women, median age 53 (range 32–58) years, who were unsuitable for sphincter repair, had an artificial bowel sphincter implanted as a one-stage procedure without colostomy cover. Clinical assessment, physiological testing, and endosonography were done before and after the operation. Plain radiography, three-dimensional endosonography, and magnetic-resonance imaging were done after the operation, to define its anatomical location. Results Median follow-up was 10 (range 5–13) months and the device was functional in five patients. In one patient, the device was removed after ulceration through the skin. Of the patients with intact devices, Wexner incontinence scores improved from a median of 19 (18–20) of 20 before the operation, to 3 (0–6) of 20 after the operation. Median anal pressure at rest significantly increased from 60 (range 30–80) cm H 2 O to 110 (100–120) cm H 2 O. Functional anal-canal length varied after the operation from 3·3 cm to 3·8 cm. There was no significant change in the maximum tolerated volume of the rectum (140 [80–230] vs 100 [75–250] mL), or rectal compliance (2·9 [2·8–6·0] cm H 2 O/mL vs 3·5 [2·3–7·3] cm H 2 O/mL). All the imaging techniques accurately located the implant relative to the anal canal and pelvic floor in each patient. Interpretation The new artificial bowel sphincter provided a good functional result in five of the six patients, the surgical procedure was straightforward, and the maximum resting anal pressure rose without affecting rectal function. The ease of visualisation of such implants in situ should aid simple management of complications, should they arise

La sensibilite de la region anale et du rectum apres chirurgie pour malformation anorectale a ete etudiee chez 32 patients (17 avec une malformation de type haut, 6 avec une malformation de type intermediaire et 9 avec une malformation de type bas). Les enfants etaient âges de 5 a 16 ans. Chez tous on a recherche s'ils pouvaient bien percevoir les sensations de toucher, de douleur, de chaleur et de froid, sur la peau perianale et dans le canal anal. La sensibilite rectale et la souplesse ont ete aussi examinees par manometrie anorectale. Tous les patients avaient des sensations normales sur la peau perianale mais moins de la moitie d'entre eux avaient des sensations normales dans le canal anal. Les patients beneficiant d'un controle intestinal normal ont presente un pourcentage significativement plus eleve de bonne sensation au toucher dans le canal anal que ceux atteints d'une incontinence fecale ou d'une constipation. Les auteurs suggerent qu'un defect sensitif du canal anal entraine une perturbation dans la discrimination entre les gaz et les feces. Les resultats de cette etude ont montre que l'elasticite reduite du neorectum et une compliance rectale basse etaient des facteurs importants pour l'incontinence fecale apres la chirurgie des malformations anorectales.

Epstein-Barr virus (EBV) can infect epithelial cells as well as B lymphocytes. Infection of the male and female genital tracts has recently been demonstrated, and it has been suggested that the virus may be sexually transmissible. In our study we investigated whether EBV can be found in the anal region of sexually active homosexual men. Anal scrapings from HIV-positive homosexual men and a heterosexual control population were investigated using the polymerase chain reaction (PCR) to screen for EBV DNA. EBV DNA was detected in 8 of 27 anal samples (29.6%) from the homosexual men and 3 of 34 samples (8.8%) from the heterosexual men. Our study shows that, like the genital tract, the anal region can harbour EBV subclinically. This finding suggests that the anal region may be a reservoir for EBV and that sexual transmission of this virus may be possible.

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.

Purpose: This study is presented to help define the role of radiotherapy in the management of epidemic Kaposi's sarcoma. Methods and Materials: Between June 1986 and June 1993, we treated 453 patients who had acquired immunodeficiency syndrome related Kaposi's sarcoma. Two hundred fifty-two patients (55.6%) had received previous treatment for their Kaposi's sarcoma: 228 (55.3%) with interferon, and 116 (25.6%) with Vinblastine. Depending on both tumour size and location, patients were treated with extended cutaneous irradiation using 4 MeV electron beam energy and/or localized irradiation using 45–100 kV x-ray (cutaneous lesions), or 4 MV x-ray (oral tumours). A total of 5015 courses of radiation therapy was given. The intention of the treatment was closely linked to the anatomic sites. Multiple courses of treatment ranging from 10 to 20 Gy (2.5 Gy/fraction, 4 times/week) were used for Kaposi's sarcoma involving conjunctiva ( n = 32 treatments), eyelids ( n = 306), lips ( n = 170), hands ( n = 208), feet ( n = 417), penis ( n = 131), oral mucosa ( n = 43), and anal region ( n = 5). A second group including other cutaneous sites (face, trunk, limbs) was treated with a dose of 30 Gy (20 Gy in 2 weeks followed by 2 weeks rest and then a second series of 10 Gy in 1 week). Results: For the first group, tolerance was generally good excluding oral cavity irradiation, with an effective palliation of symptoms (87.8% overall rate of objective responses); an enhanced mucosal reactions was noted in patients receiving oropharyngeal irradiation. For the second group, a complete regression rate of 85% was observed; tolerance was acceptable: complications were severe epidermitis with skin ulceration (5%), exsudative epidermitis (26%), dry epidermitis (60%), and varying degrees of erythema (9%). There was a significant correlation between risk of recurrence (overall recurrence rate of 71% after an average of 7.5 months) and occurrence of opportunistic infections: 85% of recurrences appeared concomitantly with accelerated course of acquired immunodeficiency syndrome. Conclusions: We conclude that radiotherapy is an efficient treatment for epidemic Kaposi's sarcoma (EKS): doses of 15.2 Gy for oral lesions and 20 Gy for lesions involving conjunctiva, eyelids, lips, hands, feet, penis, and anal region were sufficient to produce shrinkage of the tumour and good palliation of symptoms. For the other cutaneous sites, 30 Gy local field irradiation could be safely given with better short-term response. Prophylactic measures with antifungal treatment should be systematically associated with oropharyngeal irradiation, to improve tolerance to the treatment.

Perianal condylomata, a result of clinical infection with human papillomavirus, are an increasing problem. The warts lead to bleeding, itching, and discomfort in the anal region and also may be associated with anal canal neoplasia. Treatment options are numerous and include chemical caustic agents, surgical ablative methods, and immunotherapy. A high rate of recurrence is encountered despite the best of efforts.

Condylomata acuminata of the urogenital and anal region are sexually transmitted warts caused by infection of human papilloma virus. In the literature different treatment modalities are reported. We report the treatment of 323 patients (315 male, 8 female) with a mean age of 27.9 years using the Nd:YAG laser. In 65% the lesions were located in the fossa navicularis, in 37% at the glans, in 30% at the foreskin. Thirty-five percent of all patients required endoscopic treatment of the distal urethra. Two-hundred-seventy-nine patients had recurrence after unsuccessful pretreatment with surgical and chemical therapy. After a mean follow-up of 15.5 months (2 - 43 months) of 95 evaluable patients 15 showed recurrences all within the first 6 months. The advantages of Nd:YAG laser treatment of condylomata acuminata, which might be done in local anaesthesia, are a low rate of recurrences and complications, the option of endoscopic treatment and the excellent cosmetic results.© (1994) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

e21061 Background: The desmosomes, where desmogleins (DSG) and desmocollins (DSC) are major components, maintain the tissue integrity and cell-cell adherence in epithelial tissue. Our hypothesis wa...

The study was carried out in seven fetuses (ovulation ages were 16, 18, 20, 22, 26, 28, and 31 weeks, respectively) and in five full-term newborn babies. The modified Bielschowsky method and Barker's block silver impregnation were used. It was found that the muscle spindle was arranged in the puborectalis and the external sphincter muscles from the 20th week onward; the tendon organ was located in association with the musculo-tendinous junction of the puborectalis from the 20th week onward; the Pacinian corpuscle lay in the plane of cleavage between the internal anal sphincter and the external anal sphincter from the 22nd week onward, and in the presacral space from the 28th week onward, and the later lagged behind the former in development; the globular endings lay in the presacral space from the 28th week onward; and the free nerve ending was distributed in the epithelium of the anal mucosa and the epidermis around the anus from the 31st week onward. These sensory nerve endings tend to mature gradually with increasing age. It was concluded that these endings may be responsible for the reflex of the external anal sphincter and the anal sensation.

15111 Background: Molecular studies have demonstrated a direct relationship between human papillomavirus (HPV) infection and invasive cervical cancer, as well as cancer of the anal region. The role...

Although tumours and inflammatory lesions may protrude into the vaginal canal as polypoid masses, true polyps composed of a fibrovascular core covered by vaginal epithelium are rare. The fibroepithelial polyp is a benign polypoid mass 1-2 cm in average diameter occurring usually in adult women. The polyp is histologically similar to a fibroepithelial polyp of the vulval and anal region. It grows from the fornix or wall of the vagina. The squamous epithelium covering the polyp is normal but may be thickened (Fig. 21.1) and infected by HPV (Maenpaa et al. 1988). Polyps with an atypical connective tissue component have been labelled pseudosarcomatous polyp.

4233 Background: In the western world, cancers of the anal region account for 1% to 2% of all colon cancers and 3.9% of all anorectal carcinomas. The majority of these patients (75% to 80%) have sq...

A white tiger cub aged about eight months at Nandankanan Zoo exhibited signs of tenesmus, excessive anal licking and anal bleeding. The cub was restrained in a squeeze cage to examine the anal region. The presence of granulation tissue on the columnar zone of anus suggested it to be perianal fistula as described by Christie (1985) in dogs. The tiger was previously treated with a course of Gentamycin Sulphate 100 mg. b.i.d. and daily dressing with Povidone-Iodine lotion with no improvement. Hence it was decided to treat the lesion by cryotheraphy.

Figure 1. A four-year-old boy was seen by the pediatrician because of difficulty sleeping and intense pruritus in the anal region, with a three-day history of local redness in the anal region. His mother had attempted to relieve the itching by washing the area with soap and water and applying a nonprescription cream. On examination, the boy looked healthy; did not have a fever, tonsillitis, or scarlet fever; and had no symptoms or signs except a sharply demarcated area of erythema, approximately 5 cm in diameter, around the anus. There was no satellite dermatitis elsewhere. A swab of the infected . . .

Ninety-eight steers were implanted subcutaneously in the anal region with identification transponders to determine the feasibility of recovering the transponders at slaughter. Groups of 20, 19, 19, 20 and 20 steers were slaughtered 1, 35, 71, 105 and 175 days after implanting. At the first slaughter, 7 transponders were lost when the anal sphincter was removed during hide removal. At subsequent slaughterings, leaving the anal sphincter intact and removing it with a 150 mm section of rectum at the viscera table resulted in the recovery of at least 17 transponders in each group. Those not found in the rectal section were recovered from the carcass. No migration of transponders from the implant site was observed. Histological examination of tissues surrounding the transponders indicated that encapsulation had begun by 35 days after implant.

Epidermoid carcinomas of the anal region may be treated by four procedures. Radiation plays a major role in the conservative management of these tumors. Lesions of the external margin may be treated satisfactorily by external irradiation with cobalt. It is possible to control a large number of anal carcinomas by fractionated interstitial Curie therapy. A combination of external irradiation and interstitial Curie therapy may be used to treat large and extensive lesions of the anal canal.

Odontostyle length, tail length, body width, and distance of spear guiding ring from anterior end of body are about 15% larger in populations of Longidorus elongatus without males in those with. Two new species, which are very similar to L. elongatus are described. They both differ from the latter species in having longer odontostyles (105-125 μm in L. intermedius n. sp. and 128-140 μm in L. cylindricaudatus n. sp.) and a more rounded anterior end. The body in the anal region is slightly thicker than more anteriorly in L. elongatus but not in L. intermedius and L cylindricaudatus. The anterior lateral pores lie posterior to the spear guiding ring in L. elongatus, slightly anterior to the spear guiding ring in L. intermedius and at two thirds of the distance from anterior end to spear guiding ring in L. cylindricaudatus.

A technique for the electrosurgical removal of massive lesions of condyloma acuminatum in the genito-perineo-anal region is described. The method of caudal block and preoperative and postoperative management of the patient are discussed.

Interspecific differences were found betweenLemur fulvus andLemur macaco in heterosexual pair-tests.L. fulvus showed more mutual grooming and were more active in exploration thanL. macaco. The absence of a naked anal region inL. macaco females causes a virtual absence of foreheadmarking on this region by males.L. macaco males have a stronger tendency to mark the body of the female with their anogenital region after a nose-anogenital contact thanL. fulvus, indicating that the behaviour is more ritualized inL. macaco males.

When injected subcutaneously in a dose of 8 mg/kg weekly into female CBA mice, 1,2-dimethylhydrazine (DMH) induced the development of tumors of the intestine, anal region, uterus, and liver. When DMH was injected into mice aged 12–13 months the appearance of sarcomas of the uterus was observed earlier (at 8 weeks) and the incidence of tumors of the anal region rose more rapidly than in mice aged 3 months. In mice receiving DMH against the background of repeated pregnancies, a statistically significant decrease in the frequency of sarcomas of the uterus was observed (10.3% compared with 48.3% in nonpregnant mice); pregnancy did not affect the frequency of tumors of other organs. Castration had no significant effect on the time of appearance or the frequency of tumors in all situations.

This is the case of a 23-day-old female infant presenting the features of D1 trisomy syndrome with multiple anomalies such as a sloping forehead, narrow eyelids, microphthalmus, broad base of high nose, dcrognathia, flexion deformities of the Angers, simian line, rocker-bottom feet, omphalocele and breath-holding spells. Polymorphonuclear leukocytes demonstrated hypersegmentation of nuclei which disclosed hook-like appendages. In addition to the above-mentioned external anomalies, the autopsy revealed arhinencephaly, tubular stomach, horizontal heart in position and malrotation of the duodenum. Pseudomembranous necrotizing colitis was seen in the sigmoid colon and rectum. Abscesses with necrosis and hemorrhage were seen in both kidneys, pancreas, left lung, uterine cervix and the skin of the anal region. A series of this systemic infection was the immediate cause of death.

Recently 2 cases of anal carcinoma associated with fistula were experienced in our department of surgery, and one of them suggested the carcinoma originated from anal fistula.There are 29 cases of carcinoma in anal region associated with fistula clearly detailed in literatures of Japan during the 18 years from 1960 to April 1978.These cases also were reviewed and analysed in this paper.