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Male.—General coloration fuscous, with the vertex of the head, pectus, underside of abdomen, anal region, legs and base of antennal shaft mouse-grey. Fore-wings, above, covered with mouse-grey scales, amongst which are scattered irregular patches of fuscous-black scales, these predominating but forming no definite pattern; beneath, covered more uniformly with fuscous-black scales, except in the region between the first anal vein and the inner margin, which is covered with narrow elongate oval mouse-grey scales. Hind-wings above and beneath covered with fuscous scales, the inner margin furnished with long fuscous hairs. Cilia of both wings fuscous-black.

PROLAPSED hemorrhoids are usually excruciatingly painful, yet unless strangulation ensues most surgeons prefer not to operate until the marked edema has subsided. During this period of waiting, which may last several weeks, the discomfort is often extreme. Although some relief may be afforded by putting the patient to bed, administering narcotics and applying heat or analgesic ointments locally, the severe pain frequently persists, and locomotion becomes difficult To relieve the sufferings of these unhappy persons, a 1: 1,000 solution of procaine hydrochloride was injected intravenously. This is a report of our experience with that method of treatment. All the patients studied were men admitted for the treatment of severe pain in the anal region. Two types of pain appeared to be present—a sharp radiating pain and a dull pain localized in the anal region but increased by motion of the thighs. All the patients exhibited prolapsed hemorrhoids associated with edema

Larva migrans may produce para-anal pyogenic infection and symptoms referable to the anal region. The epidemiology and pathology of the disease have been outlined and the most recent advances in treatment presented.

The moist perianal skin found in many patients with pruritus ani is probably due to leakage of material from the anal orifice. This drainage material has been found to have enzymatic properties similar to trypsin. The constant presence of traces of such proteolytically active material in the anal region may be responsible for the skin irritation with the attendant sensations of intense itching. Local applications of a paste made from aluminum hydroxide gel brought prompt sustained relief to 93 out of 98 patients (or 94.8 per cent) with the “moist” type of pruritus ani but was effective in only 2 out of 36 patients (or 5.5 per cent) with the “dry” type of pruritus ani. The beneficial effects of the aluminum hydroxide are probably due to the adsorption and inactivation of the proteolytic enzyme or other chemical irritants in the analy drainage fluid.

The treatment we use is only for the properly called anal region abscesses. It does not affect para-coccygeal ones, who have no connection with the anal canal, and whose treatment is quite different.

The problems which arise from wounds of violence to the perineum, anus, rectum and colon have been discussed in terms of anatomic structure. There are two types of violence to this region, namely, direct and indirect. A review of the regional anatomy denotes five cardinal sites of involvement from deep penetrating wounds, namely the urogenital region, the anal region, the ischiorectal fossa, the retroperitoneal infrapelvic space and the pelvis or peritoneal cavity. In the early postaccident period the ischiorectal fossa and the infrapelvic retroperitoneal space are clinically silent regions. Serious complications and death from infection may be prevented if all patients are thoroughly studied by proctosigmoidoscopy and properly treated. In consideration of the bizarre types of injuries preoperative, operative and postoperative surgical treatment have been presented. The case reports clearly emphasize most ot the surgical principles involved.

Thirty cases of venereal and related anal affections seen at G. T. Hospital have been reviewed. Occupational factors in the etiology of the disease, as well as other factors, have been stressed. Multiple fissures of the nonsyphilitic type were the lesions most often encountered. The types of diseases seen and their treatment have been described.

The rarity of the occurrence of condyloma acuminatum in the anal region of the male, as well as the uncertain nosologic place of these papillary acanthomas in syphilology, has prompted me to report two cases of them which recently occurred in my hospital service. Many physicians are not clear whether condyloma acuminatum is to be considered as the result of syphilitic infection, or whether it must be considered as a vegetating papillary growth independent of syphilis. In a general way it can be stated that condyloma acuminatum is only a venereal wart, and these growths are so called because they grow around the genitals, and are preceded or associated with venereal diseases. They come on mucous membranes and on the skin moistened, macerated and irritated by abnormal purulent secretions. In ordinary cases condylomas grow as discrete excrescences. In some cases, as in mine, they become confluent and coalesce, forming large

Pilonidal sinuses which open through a primary communication into the anal canal are extremely uncommon. We here report 3 cases. The pathogenesis of these and other hair-containing sinuses in the anal region is discussed.

Of 122 patients with fistulae in ano operated upon in a 5-year period, 19 (15.6 per cent) were found to have tubercular fistulae on histopathological examination. There was no characteristic clinical picture and concomitant pulmonary tuberculosis was present in only three patients. Histological examination of the excised fistula is mandatory for the diagnosis of anal tuberculosis. There were no cases of Crohn's disease of the anal region.

An unusual patient with extensive sebaceous nevus lesions is presented. The lesions were found on the scalp and face and extended into the mouth and anal region. They were associated with premature eruption of three teeth, a cleft in the secondary palate, and a deformation of the upper third of the right auricle. Skeletal deformities were not found. Neurologic defects were not present during first months. The definitive treatment was postponed because of the patient's young age and the magnitude of the lesions.

A 60 years old postmenopausal lady was admitted in the surgery department of Islami Bank Medical College Hospital with complaints of a lump in anal region and occasional per rectal bleeding for six months. Examination revealed a small well defined globular mass in anal canal which extended from the anal verge up to lower rectum internally. Internal part was ulcerated from where foul smelling discharge was coming out. She had no history of exposure to any radiation or any surgery over the anal canal. On radiogram of the chest a cannon ball shadow was found. Incisional biopsy of the lesion revealed malignant melanoma. Abdomino-perineal resection of rectum and anal canal was done for the lesion with an uneventful postoperative period. Adjuvant therapy could not be instituted because the patient could not afford it. The patient carried herself well until she died at the ninth month postoperatively. doi: 10.3329/taj.v21i2.3803 TAJ 2008; 21(2): 180-181

We present the case of a 1-month-old female with repaired gastroschisis who presented with pneumatosis ani as the initial manifestation of necrotizing enterocolitis (NEC). NEC may present in as much as 20% of patients with gastroschisis. This relationship should prompt urgent evaluation and management as soon as any sign or symptom of the disease appears. Even though pneumatosis ani is a rare clinical finding, the anal region should always be examined in all patients where NEC is suspected.

Third- and fourth-stage larvae and adults of the filarial worm Brugia pahangi were examined by scanning electron microscopy. All stages studied have closely spaced, cuticular annulations over the entire surface, except at the extremities. Cuticular annulations of recently molted worms are narrower than annulations seen late in the preceding stage, but widen as the worm grows. The head bears eight cephalic papillae in two circles of four papillae each. There are two subdorsal and two subventral papillae in each circle. Third-stage larvae bear a central, nipplelike protuberance atop each of the inner, cephalic papillae. Three prominent, terminal, caudal papillae are lost at the third molt. Molting third-stage larvae show irregularities in the cuticular surface and desquamation of the old cuticle. The fourth-stage larva shows a globular head region, numerous tubercles in the anal region, and a pair of terminal, caudal papillae. No sexual dimorphism is seen in either third- or fourth-stage larvae. The vulva appears after the final molt, and there are major changes in the male at this time; tubercles shift to the first coil of the tail about 1 mm anterior to the anus, there are 10 to 12 nipple-bearing, perianal papillae, and the cloaca of the adult appears. The terminal, caudal papillae of adult worms are difficult to visualize and count. The orifice of the mouth is slitlike in the infective larva, but becomes triradiate after the final molt. The external orifice of amphids and phasmids could not be visualized.

In cases of death in which sodomy is suspected, careful examination of the anorectal area for trauma and the collection of a proper specimen for the detection of spermatozoa and the demonstration of elevated acid phosphatase (AP) activity are required. Whereas trauma in the anal region may be suggestive of sodomy, the presence of intact spermatozoa within the anorectal canal offers incontrovertible proof. Tests for elevated rectal AP activity in our experience, like that of Enos and Beyer [], have been disappointing.

The continuous high tone of the internal anal sphincter relaxes on rectal distension (rectosphincteric reflex, RSR). This is an important factor in allowing outward passage of rectal contents. We compared anal tone and RSR in 70 chronically constipated (Pts) and 18 healthy (C) 4-12 year old children. Anal tone was measured using a strain gauge (Honeywell MP-3 esophageal pressure transducer). The rectum was distended by injecting air into a 2.5×3 cm balloon placed in the rectum. Spontaneous variations in tone were recorded as pressure waves in the anal region in almost all individuals. Anal resting tone (ART) (mm Hg) was defined as the low points of these waves. ART varied along the length of the anal canal (LAC) and was highest at 1-1.5 cm from the anal verge. This region was used to study the presence of RSR and the amplitude of RSR relaxation (mm Hg) to 30 cc and 60 cc rectal distension. The lowest volume of air to cause RSR (≥ 5 mm Hg), the RSR threshold (RSRT), and the LAC (cm) (where tone was higher than in the rectum) were also determined. ART and RSR amplitude were significantly lower (p

A single specimen (No. 2001) of this diminutive toad is in the collection. No vomerine teeth; a large subgular vocal sac, opening on either side of the tongue by large triangular openings; parotoid very indistinct or absent; interorbital distance equal to, or slightly greater than, the width of upper eyelid. Skin generally smooth, with two large smooth folds beginning about midway on the back and continuing to the groin; numerous wrinkled folds in anal region. Fingers and toes without webs. Two well-defined palmar tubercles and two large metatarsal tubercles, the inner elongate, longer than the first toe; the outer, arising a little farther posteriorly, is much shorter and rounded. Above brownish gray, sides with brownish spots. Below grayish yellow with scattered, distinct, brown spots. This specimen differs from the typical in certain characters, especially in the strong marking df the ventral surface.

IN July and August, 1943, I was stationed near Taburi, Papua. Here I collected an apparently new Nyctimystes. At hand is a preserved example of this species, and a color painting of its appearance in life. Also available are detailed drawings of a second specimen, showing profile, anal region, open mouth, tarsus, forelimb, hindlimb, hand, foot, and general appearance; and drawings of a third example showing profile, open mouth, dorsal view of head, forearm, and foot. Measurements of these last two frogs were made, along with color descriptions from life. Five other specimens were examined and briefly described in my notes.

To the Editor.— In the January 1971 issue of theArchives, Mendoza and Helwig 1 published a detailed description of the mucinous carcinoma of the skin. According to the authors, this tumor is a clinical and histologic entity, clearly different from the basal-cell carcinoma with pseudoglandular structure. The authors emphasize how often the histologic lesions are misdiagnosed. Not less than nine of the 14 cases described were initially diagnosed as metastatic adenocarcinomas or mixed tumors of the salivary gland. Quite recently we had the opportunity of treating a patient with multiple basal-cell carcinomas; one was a tumor located in the anal region which was first classified as adenocarcinoma. Our case seems to supplement the report published by Mendoza and Helwig; a brief description of the history of the case, and the histologic lesions is given below. Report of a Case An 84-year-old woman was treated for two basal-cell carcinomas of

My object in writing this paper is to call attention to some of the most important points of practical every-day hygiene, as applied to the anal region; which, if we observed more carefully, would materially reduce the number of cases of ano-rectal diseases. Failing to heed nature's call to evacuate the bowels, or, when heeded to attempt, as soon as seated, to force or hurry defecation by bringing to bear all the power of the diaphragm and abdominal muscles and force the fecal mass, which frequently contains seeds and other substances, with sharp edges, against and through the sphincter without giving it sufficient time to become thoroughly dilated, is a very common and frequent source of these troubles. Dr. Eastman says: "This inordinate vis a tergo as often retards as expedites the matter, for human muscle, like human character, resists force, and in the case of the muscle under consideration

RECENTLY attention has been called by F. N. Blanchard' to certain peculiarities of the dorsal scales of the anal region in various species of snakes. These peculiarities are manifested as keel-like structures on smooth-scaled snakes, and as excrescences or knobs on the keels of keeled snakes. To determine the significance of these excrescences and their relation to sex and age in a species of garter snake, study was made at the suggestion of Dr. Blanchard of a series of 400 specimens of Thamnophis sirtalis sirtalis. All the specimens were loaned by the Museum of Zoology of the University of Michigan through the courtesy of Mrs. Helen T. Gaige, Curator of Amphibians. In this species of garter snake, the well developed knobbed keels usually occur in the immediate vicinity of the anus, extending dorsally as high as the third or fourth row of scales. Keels with poorly developed excrescences may occur several millimeters farther anteriorly and posteriorly, and dorsally to the median line. Ordinarily, however, even poorly developed knobs do not appear higher up than the sixth or seventh dorsal scale rows.

In 1914, Pels 1 published an article recording a case of an eruption made up of minute, shiny papules, in a marked way resembling those of lichen nitidus, to which he applied the term "miliary lichen planus." The lesions so closely resembled those of lichen nitidus that it was difficult to differentiate between this condition and lichen planus. Case 1.— The patient was a fairly well nourished white man, aged 50, with a negative family and personal history. When first seen by Dr. Pels at the Johns Hopkins Hospital dispensary, he presented an eruption which was distributed practically over the entire body, appearing more profusely in certain regions, especially about the knees, wrists, forearms, external aspects of the elbows, anal region, buttocks and around the ankles. More widely scattered lesions were present on the neck, chest, back, abdomen, arms, thighs, scrotum and penis (shaft and glands). The eruption consisted of

S. V., a Mexican woman of the peon type, aged 23, was admitted to the Denver General Hospital on Aug. 13, 1927, to be confined. On examination, the unusual growth which is illustrated was discovered; the patient denied all previous knowledge of its existence. The growth is 3⅛ inches (7.63 cm.) in length and ¾ inch (1.9 cm.) in circumference at the base, gradually tapering toward the distal extremity. When curled up, its habitual attitude, it closely resembled a pig's tail. It arose from, and was apparently intimately connected with, the external anal sphincter, being located at the anterior and the left lateral aspect of the anal opening. Distinct movement of the growth was noted on dilatation and contraction of the sphincter, while during labor pains the growth would straighten out as though composed largely of erectile tissue. It was not a prolongation of the coccyx, and no bony structure