Fistulotomy with Primary Sphincter Repair in High Anal Fistula

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Tarek Youssef Ahmed ◽  
Mohab Gamal El-din Mustafa ◽  
Mohamed Elemam Elshawy ◽  
Modaser Hashim Abdelaziz
Keyword(s):  
Anal Fistula ◽  
Therapeutic Option ◽  
Chronic Phase ◽  
Sphincter Repair ◽  
Suture Repair ◽  
Anorectal Abscess ◽  
Success Rates ◽  
Immediate Reconstruction ◽  
Effective Therapeutic Option ◽  
Fistula Recurrence

Abstract Background Anal fistula is abnormal communication between the anal canal and the perianal skin or perineum or buttocks. Anal fistula is almost always a consequence of an anorectal abscess that was drained. While the abscess represents the acute phase of the disease, fistula represents the chronic phase as the fistulous pathway may persist in about 1/3 of cases. Aim of the Work In this study we will perform fistulotomy with primary sphincter repair in high cryptoglandular fistula with assessment of recurrence rate, incontinence rate and patient satisfaction according to pain score, wound healing, discharge and return to daily activity parameters. Methods This was prospective cohort study on 30 patients of high peri-anal fistulae and fistulotomy and reconstruction (primary suture repair) of anal sphincter was done., the patients were followed up 6 months postoperatively regarding their continence using Wexner score, recurrence, discharge and their return to work by scheduled outpatient clinical examination. Results Among 30 patients only three patients complaining usual incontinence mostly as post defecation soiling. Three patients reported anal fistula recurrence: One occurred at the 5th month, while the other two occurred at the 6th month after surgery. The procedure was well tolerated by the patients as most of them complaining only minimal pain and returned to work after two weeks without need of other stage like other procedures. Conclusion Fistulotomy with primary sphincter repair is an effective therapeutic option for patients with high anal fistula. Our study demonstrated that immediate reconstruction of the sphincters after fistulotomy achieved high success rates and low risk of postoperative fecal incontinence, compared to reported rates after simple fistulotomy.

scholarly journals Convalescent Plasma Therapy: An Effective Therapeutic Option to Treat COVID-19? A Narrative Review

2020 ◽  
Vol Volume 8 ◽  
pp. 7-21
Author(s):  
Ishita Ray ◽  
Diana Fiorela Sánchez ◽  
Chris Andrea Robert ◽  
Mary Phyllis Robert
Keyword(s):  
Therapeutic Option ◽  
Narrative Review ◽  
Plasma Therapy ◽  
Effective Therapeutic Option

scholarly journals Patient profiles as an aim to optimize selection in the second line setting: the role of aflibercept

2021 ◽  
Author(s):  
B. González Astorga ◽  
F. Salvà Ballabrera ◽  
E. Aranda Aguilar ◽  
E. Élez Fernández ◽  
P. García-Alfonso ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Therapeutic Option ◽  
Scientific Evidence ◽  
Treatment Options ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Effective Therapeutic Option ◽  
Line Setting ◽  
First Line Treatment

AbstractColorectal cancer is the second leading cause of cancer-related death worldwide. For metastatic colorectal cancer (mCRC) patients, it is recommended, as first-line treatment, chemotherapy (CT) based on doublet cytotoxic combinations of fluorouracil, leucovorin, and irinotecan (FOLFIRI) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX). In addition to CT, biological (targeted agents) are indicated in the first-line treatment, unless contraindicated. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. It is in this second line setting where Aflibercept offers an alternative and effective therapeutic option, thought its specific mechanism of action for different patient’s profile: RAS mutant, RAS wild-type (wt), BRAF mutant, potentially resectable and elderly patients. In this paper, a panel of experienced oncologists specialized in the management of mCRC experts have reviewed and selected scientific evidence focused on Aflibercept as an alternative treatment.

The Need for Consensus About Liver Transplantation For Patients With Neuropsychiatric Wilson’s Disease

2021 ◽  
pp. 152692482110028
Author(s):  
Alberto Ferrarese ◽  
Patrizia Burra
Keyword(s):  
Liver Transplantation ◽  
Patient Outcomes ◽  
Wilson’S Disease ◽  
Therapeutic Option ◽  
Copper Metabolism ◽  
Wilson's Disease ◽  
Published Data ◽  
Neurological Improvement ◽  
Effective Therapeutic Option

Liver transplantation is considered an effective therapeutic option for Wilson’s disease (WD) patients with hepatic phenotype, since it removes the inherited defects of copper metabolism, and is associated with excellent graft and patient outcomes. The role of liver transplantation in WD patients with mixed hepatic and neuropsychiatric phenotype has remained controversial over time, mainly because of high post-operative complications, reduced survival and a variable, unpredictable rate of neurological improvement. This article critically discusses the recently published data in this field, focussing in more detail on isolated neuropsychiatric phenotype as a potential indication for liver transplantation in WD patients.

scholarly journals Anti-neoplastic Potential of Flavonoids and Polysaccharide Phytochemicals in Glioblastoma

Molecules ◽  
2020 ◽  
Vol 25 (21) ◽  
pp. 4895
Author(s):  
Ayesha Atiq ◽  
Ishwar Parhar
Keyword(s):  
Cancer Progression ◽  
Therapeutic Option ◽  
Normal Brain ◽  
Current Standard ◽  
Pharmacological Agents ◽  
Initiation Phase ◽  
Therapeutic Outcomes ◽  
Effective Therapeutic Option ◽  
Patient Prognosis

Clinically, gliomas are classified into four grades, with grade IV glioblastoma multiforme being the most malignant and deadly, which accounts for 50% of all gliomas. Characteristically, glioblastoma involves the aggressive proliferation of cells and invasion of normal brain tissue, outcomes as poor patient prognosis. With the current standard therapy of glioblastoma; surgical resection and radiotherapy followed by adjuvant chemotherapy with temozolomide, it remains fatal, because of the development of drug resistance, tumor recurrence, and metastasis. Therefore, the need for the effective therapeutic option for glioblastoma remains elusive. Previous studies have demonstrated the chemopreventive role of naturally occurring pharmacological agents through preventing or reversing the initiation phase of carcinogenesis or arresting the cancer progression phase. In this review, we discuss the role of natural phytochemicals in the amelioration of glioblastoma, with the aim to improve therapeutic outcomes, and minimize the adverse side effects to improve patient’s prognosis and enhancing their quality of life.

Topical Kanamycin: an Effective Therapeutic Option in Aerobic Vaginitis

2006 ◽  
Vol 18 (4) ◽  
pp. 409-414 ◽  
Author(s):  
G. Tempera ◽  
G. Abbadessa ◽  
G. Bonfiglio ◽  
E. Cammarata ◽  
A. Cianci ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Aerobic Vaginitis ◽  
Effective Therapeutic Option

scholarly journals SINGLE-DOSE PRULIFLOXACIN VERSUS SINGLE-DOSE PEFLOXACIN IN THE TREATMENT OF ACUTE UNCOMPLICATED URINARY TRACT INFECTION IN WOMEN

2010 ◽  
Vol 18 (3) ◽  
pp. 5
Author(s):  
M. CERVIGNI ◽  
G. ORTICELLI ◽  
M. BOLOGNA ◽  
F. NATALE ◽  
E. SALVATORI ◽  
...  
Keyword(s):  
Single Dose ◽  
Urinary Tract ◽  
Eradication Rate ◽  
Clinical Success ◽  
Therapeutic Option ◽  
Uncomplicated Urinary Tract Infection ◽  
Efficacy And Safety ◽  
Success Rates ◽  
The One ◽  
Tract Infections

The aim of the study was to compare the efficacy and safety of singledose prulifloxacin vs. single-dose pefloxacin in the treatment of patients with acute uncomplicated urinary tract infections. Two hundred and thirty-one female out-patients were considered microbiologically evaluable and randomly treated with 600 mg prulifloxacin (116 patients) or 800 mg pefloxacin (115 patients). The most commonly isolated uropathogen at baseline was Escherichia coli (71.4%), followed by Proteus mirabilis (10.8%) and Klebsiella pneumoniae (7.8%). Five-seven days posttreatment, the eradication rate was 97.4% and 92.2% in the prulifloxacin and pefloxacin group, respectively. The one-tailed 95% confidence interval analysis showed the equivalence of treatments. Four weeks from treatment no relapses, reinfections or superinfections were observed. The clinical success rates were 92.2% in the prulifloxacin and 84.3% pefloxacin groups. The safety profile was very good with both drugs. The results of the study make it possible to consider prulifloxacin a possible therapeutic option in patients with acute uncomplicated UTIs.

scholarly journals Differential gene expression in patients with anal fistula reveals high levels of prolactin recepetor

2017 ◽  
Vol 74 (5) ◽  
pp. 456-462
Author(s):  
Yi-Huan Song ◽  
Jian-Ming Qiu ◽  
Guan-Gen Yang ◽  
Dong Wang ◽  
A-Li Lin ◽  
...  
Keyword(s):  
Anal Fistula ◽  
De Novo ◽  
Therapeutic Option ◽  
Differentially Expressed Gene ◽  
Staining Intensity ◽  
Independent Effect ◽  
Anal Fistulas ◽  
Mediators Of Inflammation ◽  
Differential Expression Profile ◽  
Complex Cases

Background/Aim. There are limited data examining variations in the local expression of inflammatory mediators in anal fistulas where it is anticipated that an improved understanding of the inflammatory milieu might lead to the potential therapeutic option of instillation therapy in complicated cases. The aim of the present study was to examine prolactin receptors (PRLR) as inflammatory markers and to correlate their expression with both the complexity of anal fistulas and the likelihood of fistula recurrence. Methods. Microarray was used to screen the differentially expressed gene profile of anal fistula using anal mucosa samples with hemorrhoids with ageand sex-matched patients as controls and then a prospective analysis of 65 patients was conducted with anal fistulas. PRLR immunohistochemistry was performed to define expression in simple, complex and recurrent anal fistula cases. The quantitative image comparison was performed combining staining intensity with cellular distribution in order to create high and low score PRLR immunohistochemical groupings. Results. A differential expression profile of 190 genes was found. PRLR expression was 2.91 times lower in anal fistula compared with control. Sixty-five patients were assessed (35 simple, 30 complex cases). Simple fistulas showed significantly higher PRLR expression than complex cases with recurrent fistulae showing overall lower PRLR expression than de novo cases (p = 0.001). These findings were reflected in measurable integrated optical density for complex and recurrent cases (complex cases, 8.31 ? 4.91 x 104 vs simple cases, 12.30 ? 6.91 x 104; p < 0.01; recurrent cases, 7.21 ? 3.51 x 104 vs primarily healing cases, 8.31 ? 4.91 x 104; p < 0.05). In univariate regression analysis, low PRLR expression correlated with fistula complexity; a significant independent effect maintained in multivariate analysis odds ratio [(OR) low to high PRLR expression = 9.52; p = 0.001)]. Conclusion. PRLR expression inversely correlates with anal fistula complexity. Further work must define the specificity of this finding and its relationship to other conventional mediators of inflammation.

scholarly journals Docetaxel/cisplatin therapy in myasthenia gravis with hypertension/diabetes

Open Medicine ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 403-408 ◽  
Author(s):  
Guoyan Qi ◽  
Yinping Xue ◽  
Yongzhao Li ◽  
Hongxia Yang ◽  
Xiaojing Zhang
Keyword(s):  
Myasthenia Gravis ◽  
Pulmonary Infection ◽  
Therapeutic Option ◽  
Therapeutic Options ◽  
The Status ◽  
Effective Therapeutic Option ◽  
Grade Ii ◽  
Antibody Levels ◽  
Cisplatin Therapy

AbstractBackgroundTherapeutic options for thymoma-associated myasthenia gravis (MG) patients complicated with hypertension and/or diabetes post thymectomy are often conventional steroids. As the prevalence of diabetes and hypertension globally increases, other therapeutic options for these patients are of great importance.Material/methods9 patients with thymoma-associated MG complicated with hypertension and/or diabetes after thymectomy were administered 75 mg/m2 of docetaxel and 70 mg/m2 of cisplatin on day 1. The treatment could be repeated at 3-week intervals, ranging from 1 to 4 cycles according to the status of the patients. Therapeutic efficacy and side effects were evaluated. Results2 patients were complicated with type 2 diabetes, 6 with hypertension, and 1 with both diabetes and hypertension. After docetaxel/cisplain therapy, the MG symptoms were markedly improved in all patients (2, complete remission; 3, basic remission; 3, marked improvement; 1, improvement). Acetylcholine receptor (AchR) antibody levels were decreased in 8 patients. Minor adverse effects were observed in 2 patients, 1 with Grade II gastrointestinal reaction, and the other with pulmonary infection.ConclusionDocetaxel plus cisplatin might be an effective therapeutic option for thymoma-associated MG patients complicated with hypertension /diabetes post thymectomy without worsening thymoma and hypertension / diabetes.

Targeting PI3K and CDKs as effective therapeutic option for PPGLs in vitro and in vivo

2021 ◽  
Author(s):  
Sebastian Gulde ◽  
Daniela De Martino ◽  
Hermine Mohr ◽  
Swapna Satam ◽  
Alessia Foscarini ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Effective Therapeutic Option
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