China
Africa
Explore chapters and articles related to this topic
Abdominal surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Infective conditions around the anus are common. Small glands can become infected and patients can present with extremely painful abscesses. Superficial abscesses (perianal abscesses) are easy to treat by simple surgical excision. Given that these glands arise in the anal canal they may leave a false tract from the anal canal to the surface giving rise to a fistula. A fistula is an abnormal communication between two epithelial surfaces, the lining of the bowel and the skin. These can result in persistent infection and require specialist treatment. A deeper abscess may point into the ischio-rectal space (the space alongside the rectum). These abscesses are much deeper and will eventually point to the surface. Their drainage will inevitably lead to the development of a fistula, which again requires specialist treatment. When a patient presents with an abscess it is important to take a history and to examine and drain the abscess. There is no place for the management of abscesses by antibiotics alone.
Perianal Abscess
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Most perianal abscesses occur because of infection of obstructed anal glands. Bacteria can enter the intramuscular space via obstructed glands and form an abscess. Most occur posteriorly and in the intersphincteric space, where the anal glands are located. Abscesses are classified as superficial or deep in relation to the anal sphincter. If the infection bursts through the external sphincter, it will form an ischiorectal abscess. If it spreads laterally on both sides it can form a collection of sepsis, which forms a ‘horseshoe’ around the sphincters. Superior extension (supralevator abscess) beyond the puborectalis or the levators is rare and may represent iatrogenic injury (such as inadvertent injury from a fistula probe).
Perianal disease
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
A perianal abscess is a collection of pus in the perianal tissue, usually as a result of infection of the crypts of Morgagni. Without incision and drainage (I&D), a perianal abscess will become larger and more painful, eventually leading to necrosis and/or sepsis (including necrotising fasciitis). It is a frequently encountered presentation and predominantly occurs in adult males. One-third of these patients will have an underlying associated fistula which can cause recurrent infections if not recognised and treated.
Epidermoid cyst of the urinary bladder: a case report
Published in The Aging Male, 2020
Osman Akyüz, Zeynep Tatar, Soner Çoban, Mehmet Demir, Kamil Çam
Epidermoid cysts originating from the skin are thought to develop after traumatic implantation. Post-traumatic epidermal cells infiltrate deeply into the skin and proliferate. Unlike dermoid cysts, skin appendages as hair follicles, sebaceous glands and sweat glands are not found in the wall of the epidermoid cysts [1]. However, these cysts seen in solid organs are generally thought to be congenital, but their pathogenesis remains unclear [3]. Ewing et al. indicated that epidermal remnants of the Wolffian canal may be the source of renal epidermal cysts [4]. Several cases of epidermoid cysts have been reported in rare locations such as kidneys and ureters [3]. However, we encountered only one case reported in the literature as epidermoid cyst of bladder [5]. It has been indicated that the epidermoid cyst seen in this case may have emerged as a result of surgical implantation of epidermal tissue after perianal abscess surgery. In our case, the patient had undergone transurethral resection of bladder tumor. Epidermal tissue may be a congenital remnant or it may be implanted in bladder mucosa during this operation.
Cx601 (darvadstrocel) for the treatment of perianal fistulizing Crohn’s disease
Published in Expert Opinion on Biological Therapy, 2019
G. Bislenghi, A. Wolthuis, G. Van Assche, S. Vermeire, M. Ferrante, A. D’Hoore
Over the years, several surgical procedures for pCD have been proposed, but overall pCD often results in high recurrence rates, morbidity, and risk of incontinence. Extent of anorectal disease, complexity of the fistula, relation with the sphincter complex, and presence of proctitis are essential elements in determining the best treatment option. Resolution of proctitis and drainage of all perianal abscesses are mandatory steps before definitive surgical repair can be considered. Loose setons maintain patency and assure adequate drainage of the fistula tract, avoiding recurrent abscesses [31]. Early withdrawal (≤2 weeks) results in recurrent abscesses. Association of long-standing setons and medical therapy can promote resolution of anal sepsis and fistula healing [32,33] Fistulotomy assures high healing rates and few recurrences, but its role is confined to simple fistulas [34]. Given the relapsing nature of the disease, repetitive fistulotomies may result in disruption of the perineal anatomy and impairment of continence. Further options for definitive surgical repair include mucosal advancement flap (MAF), ligation of the intersphincteric fistula tract (LIFT), plugs, application of fibrin glue, fistula laser closure (FiLaCTM) device (Biolitec, Germany) and the video-assisted anal fistula treatment (VAAFT). Most of these techniques have been studied in small open-label series with reported success rates that ranged between 30% and 80% [35–39]. Adequately powered, randomized controlled trials are missing.
Pazopanib in relapsed osteosarcoma patients: report on 15 cases
Published in Acta Oncologica, 2019
Alessandra Longhi, Anna Paioli, Emanuela Palmerini, Marilena Cesari, Massimo E. Abate, Elisabetta Setola, Paolo Spinnato, Davide Donati, Ivar Hompland, Kjetil Boye
Thirteen patients (>16 years old) started with 800 mg/d, and two patients (aged 11 and 12 years) started with 400 mg/d. The 11-year-old, 65-kg boy had few side effects and increased the dose to 800 mg/d after 4 weeks. Dose reduction was necessary in 11/13 patients who started with 800 mg/d. A 53-year-old patient who had hypertension before pazopanib experienced a brain hemorrhage due to uncontrolled hypertension after 35 days of treatment. Four patients experienced a pneumothorax, of whom two needed a chest tube. Two patients (both reported an objective response, Case 2 and 3) had hand–foot syndrome (Grade 2 and 3, respectively), three patients experienced thrombocytopenia (Grade 2, 3 and 4), one had Grade 3 anemia, and three patients had hypertension. Nausea, diarrhea, and hyperbilirubinemia were other side effects reported in three patients. One patient had a perianal abscess.