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The aim of this open and randomised clinical trial was to compare, in terms of efficacy, lactitol with petroleum jelly, regarding the time before recovery of intestinal transit in patients having undergone anal surgery. Efficacy, comfort and tolerability were assessed on day 4 and 7, the convenience of treatments at the end of the period. The main criterion for efficacy was the time taken to obtain the first stool after surgery. Lactitol appears to be more effective than petroleum in terms of recovery of intestinal transit: the first postoperative stool was obtained 13 hours earlier with lactitol. This difference is statistically significant whatever the comparison: survival analysis (p = 0.0018) or t test on means (p = 0.0014). The secondary criteria for efficacy are consistent with this first result: the mean number of stools per day was significantly higher with lactitol (p = 0.046), the daily dose could be-reduced for more patients under lactitol on day 4 (p = 0.004) and, also on day 4, the general efficacy assessment was significantly in favour of lactitol (p = 0.033). The separate analysis of the items included in the comfort score shows that stools are more often "normal or soft" in the petroleum group and that pain on defecation is frequently less severe in the lactitol group. This led to a significantly higher comfort score in the petroleum group from D1 to D4 but not from D1 to D7. Tolerance was rated "good" by 97% of patients on day 7, and no statistically significant difference was observed for any of the tolerability criteria. Lactitol therefore appears to be an interesting choice, with a high benefit/risk ratio, in the treatment of the transitory constipation frequently observed immediately after anal surgery.

Anorectal lesions are uncommon in patients infected by the HIV virus (13%, 1 female and 15 males in our personal series). Certain neoplastic lesions are specific and must suggest the possibility of AIDS: Kaposi sarcoma, non-Hodgkin's malignant lymphoma and, in young subjects, intra-epithelial dysplasias, carcinomas in situ or squamous cell of the anus. Other lesions encountered in proctology should also raise the suspicion of HIV infection: anorectal lesions of STD including florid papillomatosis, most frequently (25%) in its severe and recurrent form, extensive herpetic lesions refractory to the usual treatments, Cytomegalovirus ulcers. The clinical history, specifying sexual habits, a history of drug abuse and looking for the presence of chronic diarrhoea, and a complete clinical examination looking for lymphadenopathy are important elements to be considered in favour of the diagnosis. Apart from painful emergencies requiring an immediate surgical procedure, the therapeutic of the patient's general state, the stage of the disease and the expected benefit for the patient's comfort.

Anorectal lesions in patients carrying the HIV virus are uncommon (13%, in our personal life, 1 women/15 men). The following raise the possibility of AIDS: Kaposi sarcoma, non Hodgkin's lymphoma and also with the young patients, intraepithelial dysplasia, in situ carcinoma or squamous carcinoma of the anus. Other anorectal lesions encountered in proctology, should lead to suspicion of HIV infection: anal involvement in STD, florid papillomatosis, the most frequent lesion in his serious form which recur on a interminable bases, extensive and chronic herpes, lesions refractory to standard treatment, megalovirus and ulcers. Date by history indicating sexual habits, toxicomania as well as the existence of chronic diarrhea and full physical examination scoking enlarged lymph nodes are all factors to be taken into consideration in support of the diagnosis. Apart from painful emergencies justifying immediate surgery, indications for surgery should be weighed in terms of the patient's general condition, the stage of advancement of the disease and expected benefit in terms of patient comfort.

The authors present 8 patients with malignant melanoma of the anal canal. By including these patients with those already reported in the literature, they systematically analyse the various aspects of this exceptional site. These tumors always develop at the pectinate line and transitional mucosa, while rectal localizations corresponds to contiguous extension from a melanoma of the anal canal. The clinical features are only suggestive when the lesions appear pigmented macroscopically. The histological certainty depends of the demonstration of melanin pigment and is simple when the tumor is pigmented (75% of cases). The diagnostic is more complex in the case of nonpigmented tumors, but is facilitated by electronic microscopy and certain immune markers (Proteins S 100). The constantly very severe prognosis depends of the depth of invasion, frequently assessed by Breslow's method, and lymph node invasion and metastatic spread are very frequent (88% of patients) either at the time of diagnosis or later in the course of the disease. The mean survival of 24 months does not appear to be influenced by treatment which is always surgical, either local excision of abdomino-perineal resection. Abdomino-perineal resection may be preferred in the case of a very small tumor less than 2 mm thick in the absence of any visceral metastases. Radiotherapy to extensive tumors is only palliative treatment and chemotherapy has not been found to be effective to date.

Etiopathoganeic and physiopathological conceptions of hemorrhoidal illness underline the importance of the mechanical factor in hemorrhoidal prolapse, arteriovenous shunts of sections of circulatory blockage, in surface mucous in hemorrhoidal bleeding; the role of shunts in mid-channel mucous, in neuro-vegetative dependence in the regulation of pressure and flow; the clinical factor manifest in the appearance of hemorrhoidal disorders, muscular straining, notably in constipation, genital phases, and stress-linked disorders. The therapeutic possibilities determined by these factors are clear: the advantage of a medical treatment that will link the correction of transit disorders, alimentary regularity, decongestive action of the venotropes, the value of instrumental ambulatory therapy such as sclerotherapy, elastic dressings, controlled freezing in the cases of proctorrhagia and limited prolapse. It is quite clear that the most radical treatment of hemorrhoids is surgery, as long as it is complete, and high up, which can be achieved by the techniques that treat separate clusters, with or without sphincterectomy.