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JPMA. the Journal of the Pakistan... Jun 2023Congenital perineal grove (CPG) is a rare anorectal anomaly; only 65 cases have been reported in literature. Two cases who were referred for evaluation of a lesion in... (Review)
Review
Congenital perineal grove (CPG) is a rare anorectal anomaly; only 65 cases have been reported in literature. Two cases who were referred for evaluation of a lesion in the perineum are reported here. The patients were diagnosed clinically as CPG in neonatal period and were initially managed conservatively. Surgery was required in one case as the lesion was persistent and symptomatic. A high index of suspicion is required for diagnosis of CPG to avoid parental anxiety and unnecessary diagnostic work-up and surgery. Surgery is required only in cases where the lesion persists or there is infection, pain, and ulceration.
Topics: Infant, Newborn; Humans; Female; Anorectal Malformations; Anal Canal; Perineum; Pain
PubMed: 37427639
DOI: 10.47391/JPMA.6803 -
Asian Journal of Surgery Sep 2023In this study, we introduce a surgical procedure for multiple-quadrant hemorrhoid crisis, namely Lingnan surgery, and discuss its clinical efficacy and safety.
OBJECTIVE
In this study, we introduce a surgical procedure for multiple-quadrant hemorrhoid crisis, namely Lingnan surgery, and discuss its clinical efficacy and safety.
METHODS
We performed a retrospective analysis of patients with acute incarcerated hemorrhoids who underwent Lingnan surgery at the Anorectal Department of Yunan County Hospital of Traditional Chinese Medicine of Guangdong Province from 2017 to 2021. The baseline data, preoperative condition, and postoperative condition of each patient were recorded in detail.
RESULTS
A total of 44 patients were studied. There were no cases of massive hemorrhage, wound infection, wound nonunion, anal stenosis, abnormal anal defecation, recurrent anal fissure, or mucosal eversion within 30 days after surgery, and no recurrence of hemorrhoids and anal dysfunction occurred during the 6-month follow-up after surgery. The average operation time was 26.5 ± 6.2 min (17-43 min). The average length of hospital stay was 4.0 ± 1.2 days (2-7 days). In terms of postoperative analgesia, 35 patients took oral nimesulide, 6 did not use any analgesics, and 3 required nimesulide plus tramadol by injection. The mean Visual Analog Scale pain score was 6.8 ± 0.8 preoperatively and 2.9 ± 1.2, 2.0 ± 0.7, and 1.4 ± 0.6 at 1, 3, and 5 days postoperatively, respectively. The average basic activities of daily living score was 98.2 ± 2.6 (90-100) at discharge.
CONCLUSION
Lingnan surgery is easy to perform and has obvious curative effects, providing an alternative to conventional procedures for acute incarcerated hemorrhoids.
Topics: Humans; Hemorrhoids; Retrospective Studies; Activities of Daily Living; Treatment Outcome; Prisoners; Pain, Postoperative
PubMed: 37419805
DOI: 10.1016/j.asjsur.2023.06.066 -
World Journal of Gastrointestinal... Jun 2023The distal-less homeobox () gene family plays an important role in the development of several tumors. However, the expression pattern, prognostic and diagnostic value,...
BACKGROUND
The distal-less homeobox () gene family plays an important role in the development of several tumors. However, the expression pattern, prognostic and diagnostic value, possible regulatory mechanisms, and the relationship between family genes and immune infiltration in colon cancer have not been systematically reported.
AIM
We aimed to comprehensively analyze the biological role of the gene family in the pathogenesis of colon cancer.
METHODS
Colon cancer tissue and normal colon tissue samples were collected from the Cancer Genome Atlas and Gene Expression Omnibus databases. Wilcoxon rank sum test and -test were used to assess gene family expression between colon cancer tissue and unpaired normal colon tissue. cBioPortal was used to analyze gene family variants. R software was used to analyze gene expression in colon cancer and the relationship between gene family expression and clinical features and correlation heat map. The survival package and Cox regression module were used to assess the prognostic value of the gene family. The pROC package was used to analyze the diagnostic value of the gene family. R software was used to analyze the possible regulatory mechanisms of gene family members and related genes. The GSVA package was used to analyze the relationship between the gene family and immune infiltration. The ggplot2, the survminer package, and the clusterProfiler package were used for visualization.
RESULTS
were significantly aberrantly expressed in colon cancer patients. The expression of genes were associated with M stage, pathologic stage, primary therapy outcome, residual tumor, lymphatic invasion, T stage, N stage, age, perineural invasion, and history of colon polyps. was independently correlated with the prognosis of colon cancer in multivariate analysis. were involved in the development and progression of colon cancer by participating in immune infiltration and associated pathways, including the Hippo signaling pathway, the Wnt signaling pathway, several signaling pathways regulating the pluripotency of stem cells, and infection.
CONCLUSION
The results of this study suggest a possible role for the gene family as potential diagnostic or prognostic biomarkers and therapeutic targets in colon cancer.
PubMed: 37389108
DOI: 10.4251/wjgo.v15.i6.1019 -
Annals of Medicine and Surgery (2012) Jun 2023Anorectal obstetric injuries resulting in anal sphincter damage (ASD) and rectovaginal fistula (RVF) remain a major problem. The resulting flatus or faecal incontinence...
UNLABELLED
Anorectal obstetric injuries resulting in anal sphincter damage (ASD) and rectovaginal fistula (RVF) remain a major problem. The resulting flatus or faecal incontinence is devastating. Surgical repair remains a challenge. Postpartum RVF primarily results from ischaemic pressure necrosis following obstructed labour. The fistula tract is surrounded by a fibrous scar. ASD usually results from precipitous labour. The injury heals by fibrous scar leading to varying degrees of anal incontinence. Contraction and retraction of muscles around the injury renders the defect and fibrous scar larger than the primary injury. Anorectal ultrasonography has been used to define RVF and ASD, and the associated fibrous scar.
PATIENTS AND METHODS
A retrospective review of patients who underwent transvaginal surgical repair of RVF and ASD was undertaken. Patients were preoperatively assessed for pathology and incontinence degree. Anorectal ultrasonography was used to define ASD or RVF and the associated scar preoperatively. Repair of RVF or ASD entails total excision of the scar with accurate anatomical layers reconstruction of healthy tissues.
RESULTS
There were 23 patients, 8 RVF with a mean (SD) age 29 (6.78) years and 17 ASD with a mean (SD) age 35.25 (15.90). Twenty followed obstetric trauma (6RVF, 14 ASD), 1 prior rectocoele repair (ASD), 2 rape (1RVF + 1 ASD) and 1 was idiopathic (RVF). All patients had 1 or more prior repairs except for idiopathic RVF. Operative technique entailed transvaginal complete excision of the fibrous scar and accurate anatomical reconstruction of healthy tissue layers. A colostomy was not routinely used. There were three significant postoperative complications: ASD breakdown from an infected haematoma; perianal abscess, later a sinus after drainage; and RVF repair dehiscence during early coitus. All patients had full continence after 8 months minimum follow-up.
CONCLUSION
Complete excision of the fibrous scar and accurate anatomical tissue layers reconstruction of the obstetric RVF or ASD, aided by prior ultrasonography, yielded good results.
PubMed: 37363522
DOI: 10.1097/MS9.0000000000000614 -
Journal of Biomedical Science Jun 2023The global burden of invasive fungal infections (IFIs) has shown an upsurge in recent years due to the higher load of immunocompromised patients suffering from various... (Review)
Review
BACKGROUND
The global burden of invasive fungal infections (IFIs) has shown an upsurge in recent years due to the higher load of immunocompromised patients suffering from various diseases. The role of early and accurate diagnosis in the aggressive containment of the fungal infection at the initial stages becomes crucial thus, preventing the development of a life-threatening situation. With the changing demands of clinical mycology, the field of fungal diagnostics has evolved and come a long way from traditional methods of microscopy and culturing to more advanced non-culture-based tools. With the advent of more powerful approaches such as novel PCR assays, T2 Candida, microfluidic chip technology, next generation sequencing, new generation biosensors, nanotechnology-based tools, artificial intelligence-based models, the face of fungal diagnostics is constantly changing for the better. All these advances have been reviewed here giving the latest update to our readers in the most orderly flow.
MAIN TEXT
A detailed literature survey was conducted by the team followed by data collection, pertinent data extraction, in-depth analysis, and composing the various sub-sections and the final review. The review is unique in its kind as it discusses the advances in molecular methods; advances in serology-based methods; advances in biosensor technology; and advances in machine learning-based models, all under one roof. To the best of our knowledge, there has been no review covering all of these fields (especially biosensor technology and machine learning using artificial intelligence) with relevance to invasive fungal infections.
CONCLUSION
The review will undoubtedly assist in updating the scientific community's understanding of the most recent advancements that are on the horizon and that may be implemented as adjuncts to the traditional diagnostic algorithms.
Topics: Humans; Artificial Intelligence; Invasive Fungal Infections; Polymerase Chain Reaction
PubMed: 37337179
DOI: 10.1186/s12929-023-00926-2 -
American Journal of Translational... 2023This study aimed to comprehensively evaluate perianal fistulas and their related complications using magnetic resonance imaging (MRI).
OBJECTIVE
This study aimed to comprehensively evaluate perianal fistulas and their related complications using magnetic resonance imaging (MRI).
METHODS
We enrolled 115 eligible patients who underwent preoperative perianal MRI. Primary fistulas, internal and external openings, and related complications were evaluated using MRI. All fistulas were classified according to Park's classification, Standard Practice Task Force classification, St. James's grade, and the position of the internal opening.
RESULTS
In total, 169 primary fistulas were detected in 115 patients; 73 (63.5%) patients had a single primary tract and 42 (36.5%) patients had multiple primary tracts, and 198 internal and 129 external openings were identified. Based on Park's classification, 150 (88.7%) primary fistulas were classified into the following types: intersphincteric (82, 54.7%), trans-sphincteric (58, 38.6%), suprasphincteric (8, 5.3%), extrasphincteric (1, 0.7%), and diffuse intersphincteric with trans-sphincteric (1, 0.7%) types. Based on St. James's grade, 149 fistulas were classified into grade 1 (52, 34.9%), grade 2 (30, 20.1%), grade 3 (20, 13.4%), grade 4 (38, 25.5%), and grade 5 (9, 6.1%). We detected 92 (54.4%) simple and 77 (45.6%) complex perianal fistulas and 72 (42.6%) high and 97 (57.4%) low perianal fistulas. Furthermore, we detected 32 secondary tracts in 23 (20.0%) patients and 87 abscesses in 60 (52.2%) patients. Levator ani muscle involvement and extensive soft tissue edema were detected in 12 (10.4%) and 24 (20.9%) patients, respectively.
CONCLUSION
MRI is a valuable and comprehensive tool that can not only be used to determine the general condition of perianal fistulas but also to classify them and identify related complications.
PubMed: 37303685
DOI: No ID Found -
Cureus May 2023Lymphoma is a well-known complication related to HIV infection; of these, non-Hodgkin lymphoma (NHL) is the most common subtype with Hodgkin lymphoma (HL) occurring less...
Lymphoma is a well-known complication related to HIV infection; of these, non-Hodgkin lymphoma (NHL) is the most common subtype with Hodgkin lymphoma (HL) occurring less frequently. We present a rare case of a 35-year-old male with a history of HIV/AIDS well-controlled on antiretroviral therapy (ART) with an atypical HL presentation. He arrived at the emergency department with rectal bleeding, 30-pound unintentional weight loss, and subjective fever. CT scan of the abdomen and pelvis showed a circumferential mass extending from the mid-rectum to the anus, with extensive local lymphadenopathy. He underwent multiple biopsies of the mass and adjacent lymph nodes. The pathology report showed EBV-positive lymphoma with features of classical Hodgkin lymphoma (cHL) (positive for EBV-EBER by in-situ hybridization). He was started on A+AVD (brentuximab plus doxorubicin, vinblastine and dacarbazine). The patient tolerated the chemotherapy well without significant complications. We want to encourage physicians and providers to include anorectal HL in their differential diagnosis for HIV/AIDS patients with atypical rectal malignancy presentations and subsequent reporting of these cases.
PubMed: 37303441
DOI: 10.7759/cureus.38796 -
Cell Division Jun 2023Nucleosome-localized sirtuin 4 (SIRT4) was found to function as an oncogene and tumor suppressor gene in different tumors. However, the clinical significance of SIRT4 in...
BACKGROUND
Nucleosome-localized sirtuin 4 (SIRT4) was found to function as an oncogene and tumor suppressor gene in different tumors. However, the clinical significance of SIRT4 in bladder urothelial carcinoma (BLCA) has not been assessed, nor has the function of SIRT4 in BLCA been analyzed.
METHODS
In this study, we assessed the levels of SIRT4 protein in BLCA tissues and its association with clinicopathological parameters and overall survival time of BLCA patients by immunohistochemical staining of tissue microarrays containing 59 BLCA patients. Then, we constructed BLCA cell lines (T24) with overexpression or interference of SIRT4 by lentiviral infection. The effects of SIRT4 on the proliferation, migration and invasive ability of T24 cells were investigated using cell counting kit-8 (CCK-8) assays, wound healing assays, and migration and invasion assays. Moreover, we also investigated the effect of SIRT4 on the cell cycle and apoptosis of T24 cells. Mechanistically, we explored the relationship between SIRT4 and autophagy and its role in the inhibition of BLCA.
RESULTS
We found by immunohistochemistry that SIRT4 protein levels were reduced in BLCA and that lower SIRT4 levels were associated with larger tumor volumes, later T-staging and later AJCC staging in BLCA patients and were an independent prognostic factor in BLCA patients. Overexpression of SIRT4 significantly inhibited the proliferative viability, scratch healing capacity, migratory capacity, and invasive capacity of T24 cells, while interference with SIRT4 had the opposite effect. Moreover, overexpression of SIRT4 significantly inhibited the cell cycle and increased the apoptosis rate of T24 cells. Mechanistically, SIRT4 inhibits BLCA growth by suppressing autophagic flow.
CONCLUSIONS
Our study suggests that SIRT4 is an independent prognostic factor for BLCA and that SIRT4 plays a tumor suppressor role in BLCA. This suggests a potential target for SIRT4 in the diagnosis and treatment of BLCA.
PubMed: 37301821
DOI: 10.1186/s13008-023-00091-w -
Discover Oncology Jun 2023Anal lymphomas are extremely rare. There are no relevant descriptions in professional books, and there are only a few case reports in the literature. Here, we report a...
BACKGROUND
Anal lymphomas are extremely rare. There are no relevant descriptions in professional books, and there are only a few case reports in the literature. Here, we report a new case and review the literature to summarize the clinical and pathological features of anal lymphoma.
METHODS
We described a case of anal lymphoma confirmed by pathological diagnosis, then searched the PubMed database, and finally selected 12 reported cases to be included in the study. We described the clinical and pathological characteristics of the patients.
RESULTS
Thirteen patients with anal lymphoma were confirmed. Seven men and six women with a median age of 50. There were four cases of HIV- and EBV-infected patients. The size of the tumor was 1-13 cm, all of which were diagnosed as B-cell lymphoma, and 61.5% were diffuse large B-cell lymphomas. Among the 13 patients, eight received chemotherapy or immunochemotherapy, two received radiotherapy, one received chemotherapy combined with radiotherapy, one received surgery, and one gave up treatment. Three patients died, and only 2 of 10 surviving patients had complete remission.
CONCLUSION
Anal lymphoma is extremely rare. Patients with persistent abscess complicated with HIV or EBV infection should undergo pathological biopsy to exclude anal lymphoma.
PubMed: 37273008
DOI: 10.1007/s12672-023-00706-2