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Perspectives of Nature-Oriented Pharmacotherapeutics for the Effectual Management of Hemorrhoidal Symptoms
Published in Debarshi Kar Mahapatra, Cristóbal Noé Aguilar, A. K. Haghi, Applied Pharmaceutical Practice and Nutraceuticals, 2021
Taranpreet Kaur Bamrah, Mojabir Hussen Ansari, Debarshi Kar Mahapatra
The diagnosis of the external hemorrhoids is easy as it can be seen from the outside itself. Bleeding is the common symptom of hemorrhoids; however, it can also be due to colorectal cancer. Swollen rectum and anus blood vessels are first checked by the medical practitioners as the indexed diagnosis process. A digital rectal examination is done using a gloved lubricated finger. Anoscope and proctoscope are also used in the rectal examination. Sigmoidoscope and colonoscope are concurrently used for the examination of the colon.4
Perianal disease
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
As part of a full examination focus on: Abdominal tenderness: This may suggest another cause of PR bleeding.Look for any frank bleeding externally, including the presence of clots or dried blood. If present, note the colour and appearance.Look for any external piles, or internal prolapsed piles – and note any discolouration suggesting thrombosis.Perform a DRE. Before proceeding, it may be beneficial to apply one or two syringes of Instillagel to numb the area and allow a more useful examination. If you have the experience and equipment it may be useful to perform proctoscopy if pain allows.Gently palpate any prolapsed piles to assess tenderness: Thrombosed piles are usually very tender.If not too tender, you can attempt to reduce the prolapsed piles.
Haemorrhoidal Disease
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
Austin George Acheson, Oliver Cheong Tsen Ng
The proctoscope is passed through the anal canal into the rectum. The base (upper limit) of the haemorrhoid is identified. It is important to have observed its relationship to the dentate line as described in the account of injection sclerotherapy. A rubber band ligation applied within 1 cm of the dentate line often causes intense discomfort. The base of the cushion usually lies 1.5–2 cm above the dentate line, and here the mucosal tissue can be suctioned without causing the patient discomfort.
Polyvinylidene Fluoride Mesh Use in Laparoscopic Ventral Mesh Rectopexy in Patients with Obstructive Defecation Syndrome for the First Time
Published in Journal of Investigative Surgery, 2021
Mahdi Alemrajabi, Behnam Darabi, Behrouz Banivaheb, Nima Hemmati, Sepideh Jahanian, Mohammad Moradi
This was an experimental study conducted from August 2013 to August 2017, in a single center. Inclusion criteria were: (i) at least 6 months of conservative management for constipation and ODS, (ii) history of ODS characterized by fragmented stools, need for straining at defecation, sense of incomplete evacuation, tenesmus, urgency, pelvic heaviness and self-digitation, (iii) imaging studies (defecography) suggestive of ODS (presence of anatomical and morphological changes, such as descending perineum, rectocele, enterocele, intussusception, rectal prolapse or a combined disorder and (iv) referred to colorectal surgery clinic by an internal medicine specialist after at least 10 sessions of biofeedback treatment. Exclusion criteria were: (i) prolapsed hemorrhoids or big hemorrhoidal defects, (ii) a major non mesh-related complication before discharge which required surgical interventions and mesh removal and (iii) patients who refused to continue the study. Rigid proctoscopy and conventional defecography were performed for all patients while anorectal manometer studies, colonoscopy and colonic transit time study were used selectively based on patients’ physical examination and history taking.
Rectal actinomycosis mimicking malignancy
Published in Acta Chirurgica Belgica, 2021
Akanksha Rajpoot, Chiranth Gowda, Vidya Monappa, Gabriel Rodrigues
A 56-year-old male presented with painless, post-defaecation fresh bleeding per-rectum of 2 weeks duration. General and per-abdominal examination was unremarkable. Digital rectal examination showed fresh blood and on proctoscopy rectum was full of blood clots with no haemorrhoids, fissures, fistula, growth or strictures. Blood investigations and tumour markers were normal. Colonoscopy done revealed an ulceroproliferative growth with no active bleeding near the rectosigmoid region, suggesting malignancy (Figure 1(A)). Multiple biopsies were taken and histopathology revealed chronic granulomas with fibrous stroma and cyst like spaces containing characteristic granules and gram positive bacteria suggestive of actinomycosis and negative for malignancy (Figure 1(B)). As patient had known penicillin allergy he was started on oral cephalosporin for 4 weeks. Bleeding PR gradually stopped. A repeat colonoscopy done after 3 weeks showed regression of the lesion (Figure 1(C)), hence antibiotics were continued for 4 more weeks on the recommendation of hospital infection control committee (HICC).
Evaluation of the stage classification of anal cancer by the TNM 8th version versus the TNM 7th version
Published in Acta Oncologica, 2020
Olav Dahl, Mette Pernille Myklebust, Jon Espen Dale, Otilia Leon, Eva Serup-Hansen, Anders Jakobsen, Per Pfeiffer, Inger Marie Løes, Frank Pfeffer, Karen-Lise Garm Spindler, Marianne Grønlie Guren, Bengt Glimelius, Anders Johnsson
The Nordic Anal Cancer Group (NOAC) conducted a large retrospective study of all anal cancers (including squamous cell cancer, cloacogenic and basaloid cancer; excluding adenocarcinomas) admitted to oncology departments in Sweden and Norway and Herlev University Hospital, Vejle University Hospital and Odense University Hospital in Denmark from July 2000 to June 2007. The standard examination included proctoscopy with biopsy, computer tomography (CT) of chest and abdomen, and magnetic resonance imaging (MRI) of the pelvic area was gradually introduced during the study period. CT-(18)F-fluorodeoxyglucose positron emission tomography (FDG-PET), CT-PET was not used. The majority of the patients were treated according to one of seven different NOAC protocols (NOAC 1–7), the treatments given are summarised in Table 2 [9]. Radiation dose to primary tumour and involved nodes varied between 54 and 60 Gy in combination with chemotherapy according to the stage and protocols, others were treated with radiation (54–64 Gy) or surgery alone in early stages. Elective lymph node regions received a radiation dose of 42–46 Gy, except in some centres for well differentiated T1N0 tumours, where elective inguinal lymph node irradiation was omitted. Different chemotherapy schedules were used, either one or two courses of 5-fluorouracil and mitomycin C concurrent with the radiation, or three cycles of cisplatin and 5-fluorouracil given prior to the radiation or two cycles prior and the third cycle concurrent with radiation.