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La Clinica Terapeutica 2023Crypts are small anatomical structures situated between the anal papillae, which do not cause any symptoms unless they become inflamed. Cryptitis is a localized...
INTRODUCTION
Crypts are small anatomical structures situated between the anal papillae, which do not cause any symptoms unless they become inflamed. Cryptitis is a localized infection of one or more of the anal crypts.
CASE PRESENTATION
A 42-year-old woman presented to our practice, complaining intermittently of anal pain and pruritus ani over a span of 1 year. She was referred multiple times to various surgeons, and she was treated conservatively for anal fissure without any evident improvement. The referred symptoms were increased often after defecation. Under general anesthesia, a hooked fistula probe was introduced into the inflamed anal crypt and the whole length of the crypt was layed open.
CONCLUSION
Anal cryptitis is a misdiagnosed condition. The un-specific symptomatology of the disease can easily mislead. The clinical suspicion is fundamental for the diagnosis. Patient's history, digital ex-amination, and anoscopy are essential for the diagnosis of anal cryptitis.
Topics: Female; Humans; Adult; Anal Canal; Fissure in Ano; Diagnostic Errors
PubMed: 37199352
DOI: 10.7417/CT.2023.2522 -
Clinics in Colon and Rectal Surgery Sep 2019This article addresses the natural history of the human papilloma virus (HPV) infection to anal squamous intraepithelial lesions, and onto squamous cell carcinoma of the... (Review)
Review
This article addresses the natural history of the human papilloma virus (HPV) infection to anal squamous intraepithelial lesions, and onto squamous cell carcinoma of the anus. This article provides overviews of the virology, pathophysiology, nomenclature, classification, historical terms, risk factors, clinical evaluation, differential diagnosis, and treatment of HPV infection and its sequelae.
PubMed: 31507344
DOI: 10.1055/s-0039-1687830 -
Accident; Analysis and Prevention Dec 2022In road safety research, few studies have examined driving behaviour in chronic pain cohorts. The aim of this study was to investigate driving behaviour among drivers...
In road safety research, few studies have examined driving behaviour in chronic pain cohorts. The aim of this study was to investigate driving behaviour among drivers experiencing chronic pain. We compared individuals with chronic pain with age-gender matched healthy controls. Participants completed: (i) an anonymous online survey that included participant demographics, transport characteristics, self-reported driving behaviour, and pain characteristics (ii) a response-time hazard perception test and a verbal-response hazard prediction test for drivers, and (iii) a driving diary in which participants recorded their driving over two weeks. The results showed that participants with chronic pain were not significantly worse than controls for hazard perception and prediction test scores, self-reported attention-related errors, driving errors, driving violations, and involuntary distraction. Drivers with chronic pain did report significantly more driving lapses but this effect became non-significant when variables confounded with chronic pain, such as fatigue, were adjusted for. We also found that participants who reported particularly high levels of chronic pain performed worse in the hazard prediction test compared to the control group (and this effect could not be accounted for by other variables associated with chronic pain). In addition, participants with chronic pain reported significantly higher driving workload (mental demand, physical demand, effort, and frustration) compared with controls. The findings of this study provide new insights into driving behaviour in individuals with chronic pain and recommendations for future research in terms of driving assessment and self-regulation strategies are provided.
Topics: Humans; Accidents, Traffic; Chronic Pain; Automobile Driving; Reaction Time; Perception
PubMed: 36228423
DOI: 10.1016/j.aap.2022.106856 -
Advances in Radiation Oncology 2023Chemoradiation therapy is the primary treatment for anal cancer. Radiation therapy (RT) can weaken the pelvic bone structure, but the risk of pelvic insufficiency...
PURPOSE
Chemoradiation therapy is the primary treatment for anal cancer. Radiation therapy (RT) can weaken the pelvic bone structure, but the risk of pelvic insufficiency fractures (PIFs) and derived pain in anal cancer is not yet established. We determined the frequency of symptomatic PIFs after RT for anal cancer and related this to radiation dose to specific pelvic bone substructures.
METHODS AND MATERIALS
In a prospective setting, patients treated with RT for anal cancer had magnetic resonance imaging 1 year after RT. PIFs were mapped to 17 different bone sites, and we constructed a guideline for detailed delineation of pelvic bone substructures. Patients were interviewed regarding pain and scored according to Common Terminology Criteria for Adverse Effects. Dose-volume relationships for specific pelvic bone substructures and PIFs were determined for V20 to V40 Gy mean and maximum doses.
RESULTS
Twenty-seven patients were included, and 51.9% had PIFs primarily located in the alae of the sacral bone. Patients with PIFs had significantly more pelvic pain (86% vs 23%, = .001) and 43% had grade 2 bone pain. Dose-volume parameters for sacral bone and sacral alae were significantly higher in patients with PIFs ( < .05). V30 Gy (%) for sacral bone and alae implied an area under the curve of 0.764 and 0.758, respectively, in receiver operating characteristic analyses.
CONCLUSIONS
We observed a high risk of PIFs in patients treated with RT for anal cancer 1 year after treatment. A significant proportion had pain in the sites where PIFs were most frequently found. Radiation dose to pelvic bone substructures revealed relation to risk of PIFs and can be used for plan optimization in future clinical trials.
PubMed: 36483064
DOI: 10.1016/j.adro.2022.101110 -
Acta Gastro-enterologica Belgica 2023
Review
Topics: Humans; Fissure in Ano; Pain; Anal Canal; Chronic Disease; Treatment Outcome
PubMed: 36842176
DOI: 10.51821/86.1.11310 -
Contrast Media & Molecular Imaging 2022To explore the efficacy of Chinese herbal fumigation and sitz-bath combined with red ointment in the treatment of postoperative wound healing and pain control in anal... (Randomized Controlled Trial)
Randomized Controlled Trial
Evaluation of the Effectiveness of a Combination of Chinese Herbal Fumigation Sitz-Bath and Red Ointment in Managing Postoperative Wound Healing and Pain Control in Anal Fistula Patients.
OBJECTIVE
To explore the efficacy of Chinese herbal fumigation and sitz-bath combined with red ointment in the treatment of postoperative wound healing and pain control in anal fistula patients.
METHODS
A total of 118 anal fistula patients were selected as the study population, randomly divided into two groups, i.e., the research group ( = 60) and the control group ( = 60). The control group was treated with red ointment therapy for postoperative wound healing and pain while the research group was treated with a combination of ointment and traditional Chinese medicine fumigation sitz-bath, Postoperative wound healing, pain control, and safety evaluation were compared between the two groups. Results. The total effective rate in the research group was 96.67%, which was significantly higher than that in the control group (93.10%), and the difference was statistically significant ( < 0.05). The VAS scores and postoperative wound healing times in the research group were significantly lower than those in the control group. The difference was statistically significant ( < 0.05). A day after postoperative treatment, there was no significant difference ( > 0.05) in TNF- and IL-6 levels between the two study groups; however, from day 3 to day 14 the levels were statistically different. TNF- and IL-6 levels in research group were significantly lower than those in the control group. The difference was statistically significant ( < 0.05). The incidence of postoperative complications in the research group at 6.67% was statistically significant ( < 0.05), significantly lower than 13.79% in the control group. Conclusion. Postoperative intervention with Chinese herbal fumigation and sitz-bath combined with red ointment can effectively reduce the wound healing duration and lower the degree of pain experienced by anal fistula patients, thereby improving their quality of life.
Topics: China; Fumigation; Humans; Interleukin-6; Ointments; Pain; Quality of Life; Rectal Fistula; Treatment Outcome; Tumor Necrosis Factor-alpha; Wound Healing
PubMed: 36176927
DOI: 10.1155/2022/1905279 -
Journal of Sex Research Sep 2022Prostate cancer treatments disrupt receptive anal intercourse (RAI) for gay and bisexual men (GBM). Sexual dysfunction following prostate cancer treatment may include...
Prostate cancer treatments disrupt receptive anal intercourse (RAI) for gay and bisexual men (GBM). Sexual dysfunction following prostate cancer treatment may include severe pain in the anorectum during RAI (i.e., anodyspareunia). The purpose of this study was to explore the impact of prostate cancer and its treatments on RAI among GBM. Data were from a cross-sectional online survey of 100 GBM prostate cancer survivors who reported pleasurable RAI prior to treatment. Approximately 47% of the sample reported recent RAI, which was more common among GBM in long-term relationships. RAI was also associated with engagement in other sexual behaviors (e.g., oral and insertive anal sex). Anodyspareunia was reported by 23% of the men who had attempted recent RAI. Anodyspareunia was negatively associated with mental health, performing oral sex on a partner, and bowel function. The overwhelming majority received no information from their healthcare providers about loss of RAI function prior to prostate cancer treatment. Culturally responsive cancer survivorship care may need to address the loss of RAI function for GBM prostate cancer survivors.
Topics: Bisexuality; Cross-Sectional Studies; HIV Infections; Homosexuality, Male; Humans; Male; Pain; Pleasure; Prostatic Neoplasms; Sexual Behavior; Sexual and Gender Minorities
PubMed: 34219559
DOI: 10.1080/00224499.2021.1939846 -
Annals of Medicine and Surgery (2012) Apr 2022Hemorrhoids are a common coloproctology problem and among 10% of cases need surgical intervention. However, the established surgical interventions still have many...
INTRODUCTION
Hemorrhoids are a common coloproctology problem and among 10% of cases need surgical intervention. However, the established surgical interventions still have many complications.
CASE PRESENTATION
We reported three female patients, who presented with circular 3rd degree internal hemorrhoids. The surgical treatment was performed with pre-operative anal dilatation using a 33 mm dilator for 20 minutes, followed by triangle incision above the dentate line. The hemorrhoid excision was performed, and the wound was sutured with simple interrupted radial sutures using a multifilament absorbable 3-0 thread. There were neither complaints of pain, bleeding, anal incontinence, anal stenosis, wound dehiscence, nor recurrence at the first, second, and fourth weeks of follow-ups in all patients.
DISCUSSION
Post-operative bleeding, pain, and anal incontinence are common after an open hemorrhoidectomy, while suture breakage and anal stenosis were reported after the old technique of closed hemorrhoidectomy. Stapled hemorrhoidectomy had less complications but requires a relatively more expensive cost for the device itself. We performed a combination of preoperative anal dilatation, above dentate line triangle incision, and simple interrupted radial sutures to treat the patients with 3rd degree internal hemorrhoids, which resulted in no post-operative complications within the first month of follow-up.
CONCLUSION
A combination of preoperative anal dilatation, above dentate line triangle incision, and radial suture technique is a simple and effective surgical option for treating a 3rd degree hemorrhoid.
PubMed: 35340326
DOI: 10.1016/j.amsu.2022.103467 -
Cureus Apr 2023Background Anal fistulas are a common complication of perianal abscesses. The treatment of anal fistulas is challenging, with persistent and high recurrence rates. The...
Background Anal fistulas are a common complication of perianal abscesses. The treatment of anal fistulas is challenging, with persistent and high recurrence rates. The aim of this study was to evaluate the efficacy and cost-effectiveness of laser ablation compared to fistulotomy in the treatment of anal fistulas. Materials and methods The patients were examined for external and internal openings of the fistula, its number, length, type, relationship with the sphincters, and any previous history of abscess or proctological surgery. The surgical procedures, complications, incontinence, recurrence, and recovery time were evaluated and compared between the two groups. The laser ablation group received an intermittent laser application at a wavelength of 1470 nm and 10 watts for three seconds, while the fistulotomy group underwent cutting of the fistula tract with electrocautery while keeping a stylet in place. Results A total of 253 patients were included in this retrospective study, with 149 patients undergoing fistulotomy and 104 patients undergoing laser ablation. The patients were evaluated based on the type, number, and location of internal and external openings, and the length of the fistula tract according to the Parks classification. The mean follow-up period was 9.0±4.3 months. The results showed that the laser group had a shorter time to return to work and less postoperative pain compared to the fistulotomy group. However, the recurrence rate was higher in the laser group. The recurrence rate was also found to be higher in patients with low transsphincteric fistulas and in patients with diabetes mellitus. Conclusion Our study findings indicate that while laser ablation may be associated with less pain and quicker recovery time, it may also have a higher recurrence rate compared to fistulotomy. We believe that laser ablation is a valuable option for surgeons to consider early on in the treatment process, especially in cases where fistulotomy is not suitable.
PubMed: 37153265
DOI: 10.7759/cureus.37053 -
Emergency Medicine International 2022The aim of the study is to explore the impact of perioperative pain care management on patients' pain, comfort, and defecation in anorectal surgery.
PURPOSE
The aim of the study is to explore the impact of perioperative pain care management on patients' pain, comfort, and defecation in anorectal surgery.
METHODS
From January to December 2021, 126 patients who underwent anorectal surgery in our department were selected for the study and were randomly divided into a study group and a control group of 63 patients each after consent was obtained from the patients. The control group was given the usual care protocol and the study group was given the perioperative pain care management on top of the usual care. The two groups of patients were compared in terms of postoperative anal pain rating, comfort score, time to first bowel movement and time spent in bowel movement, the Pittsburgh sleep quality index (PSQI) scores at night, related complications, and satisfaction with care.
RESULTS
① Postoperative anal pain was less severe in the study group than in the control group ( < 0.05). ② Postoperative comfort scores were higher in the study group than in the control group ( < 0.05). ③ The time to first bowel movement and its duration after surgery were shorter in the study group than in the control group ( < 0.05). ④ Patients in the study group had lower postoperative night-time PSQI scores than the control group ( < 0.05). ⑤ Patients in the study group had a lower rate of postoperative complications than the control group ( < 0.05). ⑥ Patients in the study group had higher postoperative care satisfaction scores than the control group ( < 0.05).
CONCLUSION
The application of perioperative pain care management to patients undergoing anorectal surgery plays an important role in reducing anal pain, improving treatment comfort, and relieving difficult defecation symptoms, with significant improvement in postoperative sleep quality and reduction in complications. It is worthy of clinical reference and promotion.
PubMed: 36034481
DOI: 10.1155/2022/9885540