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Colorectal Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Anatomy of the anal canal defining the types of tumours➢ Two categories of tumours arise in the anal region.➢ Tumours that develop from mucosa (glandular, transitional or nonkeratinizing squamous) are termed anal canal cancers.➢ Tumours that arise within the skin at or distal to the squamous mucocutaneous junction are termed perianal or anal margin cancers.
Stomas
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
John R.T. Monson, Iain Andrew Hunter
Partial dehiscence of the mucocutaneous junction is not uncommon. This will usually heal in time but will require additional wound care input. It may actually be the consequence of a parastomal abscess in the subcutaneous space that has essentially discharged via the junction. Precise appliance application, convex appliances and skin protection will help to minimise associated symptoms of leakage and excoriation. The dehiscence is best included in the appliance aperture to prevent dislodgement of the flange by discharge. A specialised wound stoma nurse can usually manage the skin issues that arise following minor dehiscence, or early retraction and immediate revision is usually not indicated. For very troublesome stomas, a faecal containment system such as Flexiseal or even a large Foley catheter can be used to minimise peristomal contamination.
The rectum and anal canal
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
Below the mucocutaneous junction is anal skin, which: has somatic sensation and is as sensitive as skin;receives its arterial blood supply from the iliac vessels;drains venous blood into the iliac veins;drains lymph into the inguinal lymph glands.
Cholesteatoma in chronic otitis media secondary to pars tensa perforation
Published in Acta Oto-Laryngologica, 2023
Caili Ji, Xiaowen Zhang, Xudong Yan, Songli Cao, Tao Fu
The mucocutaneous junction subsequent to the migration of keratinized squamous epithelium was the second condition for acquired cholesteatoma. Sudhoff H et al. found entrapped islands of mucosa in the leading edge of cholesteatoma [15]. In the same way, Jackler RK put forward a new theory that mucosal traction was another factor in the formation of cholesteatoma apart from the squamous epithelium migration [14]. According to this new theory, when the inner layer of the tympanic membrane invaginated and encountered the mucosa layer of the ossicles, the two layers of mucosa became reabsorbed. As a result, the squamous and fibrous layers of the membrane will connect directly to the surface of the ossicles. In other words, when the squamous epithelium connected directly to the mucosa of tympanic cavity, it would create a pre-cholesteatoma condition [4,16]. It was further validated in our current study: 97% cholesteatoma cases in our study were precisely approved with adhesion in the perforation edge under the endoscope or during the operation.
Sacral examination in spinal cord injury: Is it really needed?
Published in The Journal of Spinal Cord Medicine, 2018
Rita Hamilton, Steven Kirshblum, Seema Sikka, Librada Callender, Monica Bennett, Purvi Prajapati
This was a prospective, single blinded study. A survey was created that asked study participants to describe the presence or absence of sacral function for light touch (LT), sharp dull discrimination utilising a pin (pin-prick (PP) sensation), deep anal pressure (DAP) and voluntary anal contraction (VAC) using side-specific questions (see Appendix 1). Demographic data was collected including age, sex, race, level of injury, time since injury, household income and highest level of education. The self-report questions were asked by nursing staff before the patient was seen by the physician in the outpatient setting, and the results of this survey were blinded from the physician who performed the sacral exam (see Appendix 1 for the survey). The sacral exam was performed according to the ISNCSCI as part of the standard of care performed during their regularly scheduled appointment. The sharp/dull discrimination test involved use of a clean safety pin and light touch sensation with a cotton swab on either side of the anal mucocutaneous junction. The digital rectal exam was then performed according to the described Standards. The examiner then documented the results of the exam and remained blinded to the self-report responses. The exam results were extracted from the medical record and recorded on the case report forms.
Clinical Accuracy of an Advanced Corneal Topographer with Tear-Film Analysis in Functional and Structural Evaluation of Dry Eye Disease
Published in Seminars in Ophthalmology, 2020
Jihei Sara Lee, Ikhyun Jun, Eung Kweon Kim, Kyoung Yul Seo, Tae-Im Kim
All subjects underwent slit-lamp biomicroscopy examinations as well as clinical tests that included fluorescein tear break-up time (FBUT) and Schirmer 1 test. The subjects were instructed to not use any eyedrops for 2 hours before examinations. For FBUT measurement, a single fluorescein strip (Haag-Streit, Koeniz, Switzerland) was applied over the inferior meniscus. In order to control for possible variations in fluorescein volume and concentration, the average value of 3 repeated tests was taken as the final measurement. The Schirmer test was conducted using a standard paper strip (Eagle Vision, Memphis, TN, USA). The strips were placed without topical anesthesia and left for 5 minutes before the final reading. Lid margin abnormalities were assessed with slit-lamp biomicroscopy. The following four factors were used to grade abnormalities: vascular engorgement, plugged meibomian gland orifice, displacement of the mucocutaneous junction and irregularity of the lid margin.6–8 Based on the presence of any of the four factors, abnormalities were graded from 0 to 4. The meibum quality was assessed based on the secretion from the eight glands in the center of the lower lid and graded out of 24 points.6,7 The expressibility of meibum was graded semi-quantitatively also by assessing the secretion after applying firm digital pressure onto the five lower lid glands.6,9 The protocol is defined in detail elsewhere.10 The slit-lamp examinations were conducted by a single clinician (I.J) for consistency. During the same visit, the subjects were asked to fill out the Ocular Surface Disease Index (OSDI) questionnaire. The questions were taken from the set developed by the Outcomes Research Group at Allergan (Irvine, CA, USA).