scholarly journals The yield of routine histopathology in fistula-in-ano: a retrospective analysis

2020 ◽  
Author(s):  
Dharmabandhu Nandadeva Samarasekera ◽  
Umesh Jayarajah ◽  
Isuru S Almeida
Keyword(s):  
Histological Analysis ◽  
Significant Proportion ◽  
Conclusive Evidence ◽  
Histological Evaluation ◽  
Histopathological Analysis ◽  
Internal Opening ◽  
Clinical Prediction ◽  
Fistula In Ano ◽  
Previous Diagnosis ◽  
Associated Symptoms

Abstract Objective Fistulae-in-ano with a specific aetiology such as TB and Crohn’s are usually complex and challenging to treat. This study was aimed to determine the yield of routine histological analysis in fistula-in-ano, in detecting specific aetiology. Histopathology reports of all patients without a previous diagnosis, who underwent surgery for fistulae-in-ano were retrospectively analysed. Results A total of 215 patients [median age:40 years(range:14–73), males = 178(82.8%)] were analysed. The majority(75%,n = 161) were simple fistulae and recurrent(67%,n = 145). Histological evaluation revealed inflamed granulation tissue in 94.9%(n = 204) of patients. Five(2.3%) patients had conclusive evidence of Crohn’s disease and three(1.4%) had tuberculosis. One patient(0.5%) had evidence of adenocarcinoma with mucinous differentiation. Significant proportion of fistula with a specific aetiology were complex fistulae (82%vs.22%,p < 0.001) and associated with abscess/collections (45.5%vs.11.8%, p < 0.001). Age, type of fistula, level of internal opening, recurrence and presence of haemorrhoids were comparable in those with and without a specific aetiology. One patient with Crohn’s and those with TB did not have any associated symptoms to suggest the diagnosis. Routine histopathological analysis in patients presenting with fistula in-ano should be performed as clinical prediction based on the nature of fistula may not be always accurate.

scholarly journals The role of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano: an observational study

2020 ◽  
Author(s):  
Ruvindu H Waidyasekera ◽  
Umesh Jayarajah ◽  
Dharmabandhu Nandadeva Samarasekera
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Observational Study ◽  
Incidental Findings ◽  
Flexible Sigmoidoscopy ◽  
Internal Opening ◽  
Fistula In Ano ◽  
Recurrent Fistula ◽  
Associated Symptoms

Abstract Objective: Flexible sigmoidoscopy is useful to look for an underlying aetiology in fistula-in-ano. This study was aimed to assess the yield of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano. A retrospective analysis of 159 consecutive patients with fistula-in-ano who underwent routine flexible sigmoidoscopy was performed. Sigmoidoscopy findings were recorded on a standard uniform format using a computer database. Those with a known aetiology were excluded. Results: The median age was 39(range:14-74) years and the majority were males(n=128,80.5%). Forty-nine patients(30.8%) presented with a recurrent fistula-in-ano. On flexible sigmoidoscopy, internal opening was seen in only 23 patients (14.4%). Furthermore, incidental findings of haemorrhoids (n=5, 3.1%) and polyps (n=7, 4.4%) were found. One patient(0.6%) had a healed anal fissure, 5 patients(3.1%) had inflamed mucosa and 2 patients(1.3%) had ulcers. Only two patients with inflamed mucosa were diagnosed to have Crohn’s disease on histology. Therefore, flexible sigmoidoscopy was not helpful in the majority to locate the internal opening. Only two patients had evidence of an underlying aetiology, which was Crohn’s disease. However, they had recurrent complex fistulae and other associated symptoms. Therefore, flexible sigmoidoscopy may be reserved for selected group of patients with symptoms of an underlying aetiology.

scholarly journals The role of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano: an observational study

2020 ◽  
Author(s):  
Ruvindu H Waidyasekera ◽  
Umesh Jayarajah ◽  
Dharmabandhu Nandadeva Samarasekera
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Observational Study ◽  
Incidental Findings ◽  
Flexible Sigmoidoscopy ◽  
Internal Opening ◽  
Fistula In Ano ◽  
Recurrent Fistula ◽  
Associated Symptoms

Abstract Objective: Flexible sigmoidoscopy is useful to look for an underlying aetiology in fistula-in-ano. This study was aimed to assess the yield of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano. A retrospective analysis of 159 consecutive patients with fistula-in-ano who underwent routine flexible sigmoidoscopy was performed. Sigmoidoscopy findings were recorded on a standard uniform format using a computer database. Those with a known aetiology were excluded. Results: The median age was 39(range:14-74) years and the majority were males(n=128,80.5%). Forty-nine patients(30.8%) presented with a recurrent fistula-in-ano. On flexible sigmoidoscopy, internal opening was seen in only 23 patients (14.4%). Furthermore, incidental findings of haemorrhoids (n=5, 3.1%) and polyps (n=7, 4.4%) were found. One patient(0.6%) had a healed anal fissure, 5 patients(3.1%) had inflamed mucosa and 2 patients(1.3%) had ulcers. Only two patients with inflamed mucosa were diagnosed to have Crohn’s disease on histology. Therefore, flexible sigmoidoscopy was not helpful in the majority to locate the internal opening. Only two patients had evidence of an underlying aetiology, which was Crohn’s disease. However, they had recurrent complex fistulae and other associated symptoms. Therefore, flexible sigmoidoscopy may be reserved for selected group of patients with symptoms of an underlying aetiology.

scholarly journals A comparative study in the management of fistula in ANO using various modalities

2018 ◽  
Vol 5 (6) ◽  
pp. 2223 ◽  
Author(s):  
Ramachandra M. L. ◽  
Mayank Garg
Keyword(s):  
Fistulous Tract ◽  
Selection Method ◽  
Fistula Tract ◽  
Internal Opening ◽  
Necrotic Tissue ◽  
Fistula In Ano ◽  
Sphincter Function ◽  
Medical College ◽  
Operative Complications ◽  
Comparative Prospective Study

Background: Fistula in ano is a track that connects deeply the anal canal or rectum to the skin around the anus. Fistula in ano most commonly follows an anorectal sepsis1. The main principles of management of anal fistula are closure of internal opening of fistula tract, drainage of infection or necrotic tissue, and eradication of fistulous tract with preservation of sphincter function. The objectives were to compare the various aspects like per operative complications, post-operative complications, mean hospital stay in the treatment of fistula in ano using various modalities like fistulotomy, fistulectomy, setons and lift procedure.Methods: This is a randomised, comparative, prospective study of 80 cases of fistula in ano, presenting at surgical opd of K.R. Hospital, Mysore attached to Mysore Medical College and research Institute. Out of which, 20 cases are treated by fistulectomy, 20 by seton, 20 by fistulotomy and the rest 20 cases by LIFT procedure by random selection method, during period of NOVEMBER 1, 2016 to 31st October 2017.Results: Most common age of presentation is 31-40 years and more common in males then females (M:F= 2.3:1 ). Per operative complications include bleeding seen more in patients undergoing fistulectomy. Per operative course of LIFT procedure patients was complication free. Postoperative pain seen more in patients undergoing setons procedure.Conclusions: we conclude that LIFT procedure and Fistulotomy were acceptable procedures for simple, uncomplicated low lying and high lying fistula.

scholarly journals Isolated Crohn’s Disease of the Appendix Presenting as Acute Appendicitis in a 60-Year-Old South Asian Female: A Case Report, Review of Literature, and Follow-Up Recommendations

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Pamathy Gnanaselvam ◽  
Dhanushka N. Weerakoon ◽  
W. A. M. Wijayasuriya ◽  
Vishva Samidi Mohottala ◽  
B. M. E. S. Sinhakumara ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Case Report ◽  
Crohn's Disease ◽  
Acute Appendicitis ◽  
Clinical Findings ◽  
Additional Treatment ◽  
Histological Evaluation ◽  
Histopathological Analysis ◽  
Review Of Literature

The isolated appendiceal Crohn’s disease without preceding bowel symptoms is a rare phenomenon, especially in older patients. In this case report, we present a 60-year-old female with isolated appendiceal Crohn’s disease presenting with acute appendicitis. She presented with classical features of appendicitis with elevated inflammatory markers. She underwent an appendectomy which showed an excessively swollen, oedematous, and reddish appendix with swelling extending to the base of the caecum. Histological evaluation was suggestive of Crohn’s disease, and subsequent colonoscopy was unremarkable. Following appendectomy, she was asymptomatic without any recurrence of disease. The atypical morphological appearance of the appendix should raise suspicion of Crohn’s disease. This case highlights the importance of histopathological analysis of the specimen, especially in abnormal clinical findings. The prognosis of such patients seems to be good, and additional treatment is rarely needed.

Reconstructed interfollicular feline epidermis as a model for Microsporum canis dermatophytosis

2007 ◽  
Vol 56 (7) ◽  
pp. 971-975 ◽  
Author(s):  
Jeremy Tabart ◽  
Aline Baldo ◽  
Sandy Vermout ◽  
Betty Nusgens ◽  
Charles Lapiere ◽  
...  
Keyword(s):  
Histological Analysis ◽  
Pathogenic Fungus ◽  
Basal Layer ◽  
Histopathological Analysis ◽  
Microsporum Canis ◽  
Living Tissue ◽  
Cutaneous Infection ◽  
Interfollicular Epidermis

Microsporum canis is a pathogenic fungus that causes a superficial cutaneous infection called dermatophytosis. The complexity of mechanisms involved in dermatophytic infections makes relevant in vivo studies particularly difficult to perform. The aim of this study was to develop a new in vitro model of M. canis dermatophytosis using feline fetal keratinocytes in reconstructed interfollicular epidermis, and to investigate its relevance in studying the host–pathogen relationship. Histological analysis of reconstructed interfollicular feline epidermis (RFE) revealed a fully differentiated epidermis. A proliferation assay showed replicating cells only in the basal layer, indicating that RFE is a well-stratified living tissue, leading to the formation of a horny layer. Histopathological analysis of RFE infected by M. canis arthroconidia revealed that the fungus invades the stratum corneum and produces SUB3, a keratinase implicated in the infectious process. In view of these results, an M. canis dermatophytosis model on RFE seems to be a useful tool to investigate mechanisms involved in natural M. canis feline infections.

scholarly journals Understanding New Ideas in Cryptoglandular Fistula-in-Ano

2021 ◽  
Author(s):  
Kenneth K.T. Voon
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Internal Opening ◽  
Anorectal Abscess ◽  
Fistula In Ano ◽  
Chronic Fistula ◽  
Secondary Intention ◽  
Disease Pattern ◽  
New Ideas ◽  
Complex Features

Outcomes of surgical treatment for anorectal abscesses and chronic fistulas varies widely, as there is lack of unified classification and systematic surgical approach to address a wide range of disease pattern. Acute anorectal abscess and chronic fistula-in-ano should be considered the same disease at both end of a spectrum. This article describes in detail the pathogenesis and relevant anorectal anatomy to aid understanding of a new concept of classifying anorectal abscess and fistula based on natural patterns. A better understanding of patterns allows more accurate surgical treatment. Recent evidence shows that definitive surgical treatment for anal fistula during acute abscess stage is safe and feasible. An optimum surgical treatment should focus on eradication of intersphincteric infection, removal of secondary branches or abscesses, allow healing by secondary intention and preserve continence as best as possible. Common challenges faced by clinicians include confusion in classification, inaccurate delineation of fistula, challenging acute abscesses, unable to locate internal opening and facing complex features such as high fistula or multiple branches. Suggested solutions are discussed and a structured treatment strategy according to types and patterns is proposed. Surgical treatment should follow the principles above and combination of surgical techniques is beneficial compared to individual modality.

scholarly journals Study the Role of Loose versus cutting of Seton in Treatment of High Perianal fistula in a District Hospital of Health Insurance

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S Abdelhameed ◽  
I M H Elghazawy ◽  
E A Elsayed
Keyword(s):  
Anal Fistula ◽  
Low Cost ◽  
Perianal Fistula ◽  
Dentate Line ◽  
Internal Opening ◽  
Fistula In Ano ◽  
One Year ◽  
Definition Of ◽  
A Prospective Study ◽  
High Perianal Fistula

Abstract When the track reaches the skin or another epithelialized surface then a fistula is formed. Anal fistula were classified on the basis of its relationship to the sphincters. The definition of high or low describes the height of the track as it traverses the sphincter muscles and not the position of the internal opening which is almost without exception at the dentate line. More accurately according to parks classification fistula in ano can result in an abscess between the internal and external sphincters, which in turn can spread to other parts of the perianal region. Infection can then track in many directions from this focus in the intersphincteric plane. Background Anal fistula is an abnormal communicative small channel that has an internal opening and an external opening and connected by the primary track. Our study evaluate the effectiveness of seton in high variety anal fistula. Objectives Evaluation the efficacy and safety of seton as surgical management of high anal fistula. Methods: This is a prospective study done on 30 patients in ELNile hospital in one Year period with high variety of anal fistula which is above the dentate line and were treated with seton .Outcome measured during follow up period were- successfully healed, recurrence, incontinence, percentage of complications and patients satisfaction. Result Among 30 patients mean age was 42.2+_6.8 years. Overall outcome of the patients showed-fistula completely healed in 27 patients, incontinence occurred in 3 patients and recurrence occurred in 3 patients. Conclusion Seton is relatively safe, effective and low cost for the management of high anal fistula with low rate of incontinence. It can therefore, be recommended as the standard of treatment for high variety fistula in ano.

scholarly journals Histological evaluation of the intestine of broiler chickens: comparison of three sampling methods

2021 ◽  
Vol 42 (6) ◽  
pp. 3247-3258
Author(s):  
Marielen de Souza ◽  
◽  
Claudineia Emidio Cicero ◽  
Maísa Fabiana Menck-Costa ◽  
Larissa Justino ◽  
...  
Keyword(s):  
Broiler Chickens ◽  
Histological Analysis ◽  
Relevant Information ◽  
Histological Evaluation ◽  
Standard Diet ◽  
Sample Collection ◽  
Tissue Samples ◽  
Transversal Section ◽  
Significant Difference ◽  
Precise Diagnosis

After the growth-promoting antibiotics prohibition, intestinal health became an increasing concern worldwide in poultry farming. The intestinal histological evaluation is an inexpensive technique that brings relevant information, but in poultry, the immediate process of intestinal post-mortem autolysis interferes directly on the samples quality for histological analysis hindering a precise diagnosis. This study aimed to standardize a technique for broilers’ intestines sample collection and fixation for histological analysis. Seven broiler chickens received a standard diet until 23 days of age when they were euthanized. Fragments of duodenum, jejunum, and ileum were collected using three methods: intestine strips, transverse section, and Swiss roll and posteriorly fixed in 10% buffered formalin and bouin solution. Tissue samples were submitted for histological (number of villi and viable villi per field) and morphometrical (villi height, crypt depth and villi:crypt ratio) evaluations and the results analyzed statistically. A significant high number of villi and viable villi per field in all regions was observed in the Swiss roll method. In the duodenum (p= 0.0066) and jejunum (p= 0.0058) an interaction between the Swiss roll method and the fixative buffered formalin was observed in the viable and number of villi per field, respectively. Regarding the morphometrical analysis significant differences were observed, in the jejunum villi height sampling by the methods Swiss roll (1,157.66 ± 148.25 μm, p= 0.0015) that showed the highest mean. Deeper crypt depths were observed in the jejunum (156.59 ± 15.68 μm, p= 0.0002) and ileum (131.13 ± 15.01 μm, p= 0.0006) collect by the Swiss roll method. An interaction between the bouin fixative was also observed in the jejunum (p= 0.0223) for this variable. Duodenum sampling by transversal section (12.68 ± 1.45 μm, p= 0.0076) was the only segment that had a significant difference for villi:crypt ratio, showing the highest mean. It can be concluded that the Swiss roll technique was the best method for morphometrical evaluation of the chickens’ intestines, since the highest counts of villi per field and viable villi per field were obtained, while buffered formalin was considered as the best fixative.

scholarly journals Clinical and diagnostic profile of patients with anal fistula: a cross sectional study from Vilasrao Deshmukh Government Institute of Medical Sciences, Latur, Maharashtra

2020 ◽  
Vol 7 (8) ◽  
pp. 2494
Author(s):  
Praffula V. Mahakalkar ◽  
Ganesh Swami ◽  
Halnikar Chandrashekhar S. ◽  
Anant A. Takalkar
Keyword(s):  
Anal Fistula ◽  
Cross Sectional Study ◽  
Internal Opening ◽  
Age Group ◽  
Cross Sectional ◽  
Female Ratio ◽  
Fistula In Ano ◽  
Surgical Department ◽  
Male Predominance ◽  
External Opening

Background: Anal fistulas are one of the commonest causes for a persistent discharge seropurulent in nature that irritates the skin in the neighbourhood and leads to discomfort. Fistula-in-ano is seen quite frequently in perirectal perianal suppuration. The objective of this study to study the clinical profile and diagnosis of anal fistula at surgical OPD of VDGIMS.Methods: The present cross-sectional observational study was carried out in patients with fistula-in-ano admitted at surgical department of VDGIMS, Latur during the period of 2017-19 in 50 diagnosed patients. Data was analysed by using SPSS 24.0 version IBM USA.Results: Majority of the patients with anal fistula were from 41-50 years age group i.e. 15 (30%) and males were predominantly affected 40 (80%) compared to females i.e. 10 (20%). Male to female ratio was 4:1. Perianal discomfort was the commonest symptom in all patients i.e. 100%. It is followed by perianal discharge complained by 54% and perianal itching in 38% cases. The anterior position of external opening is found to be significant (p<0.05). Fistulogram showed external opening in all patients i.e. 50 cases whereas internal opening in 46 (92%) cases. Findings of MRI revealed that anal fistula was intra sphincteric in 28 cases i.e. 56%, extra sphincteric in 2 cases i.e. 4% and trans sphincteric in 20 cases i.e. 40%.Conclusions: Commonest age group affected in our study was 40-50 years with male predominance. Perianal discomfort and discharge were the commonest symptom. E. coli was the predominant organism isolated. Fistulogram and MRI is useful in detecting the aetiology of fistula in ano.

scholarly journals Histological evaluation of the effects of corticotomy on induced orthodontic movement in rats

2017 ◽  
Vol 46 (6) ◽  
pp. 368-373 ◽  
Author(s):  
Patrícia Pigato SCHNEIDER ◽  
Lais Pavan SILVA ◽  
Fernando José Lopes de Campos CARVALHO ◽  
Luís Filipe Siu LON ◽  
Luiz Gonzaga GANDINI JÚNIOR
Keyword(s):  
Histological Analysis ◽  
Tooth Movement ◽  
Initial Period ◽  
Invasive Procedure ◽  
Histological Evaluation ◽  
Control Group ◽  
Coil Spring ◽  
Orthodontic Movement ◽  
Spring Force ◽  
Movement Group

Abstract: Introduction: Alveolar corticotomy is a surgical procedure used to increase the velocity of tooth movement. Objective Identify histological evidence of the effect of corticotomy on orthodontic movement in rats. Material and method Forty-five Wistar rats (Rattusnorvegicus Albinus) were equally divided into three groups: Control Group (CG) - no tooth movement or corticotomy; Movement Group (MG) - tooth orthodontic movement only; and Corticotomy and Movement Group (CMG) - tooth orthodontic movement surgically assisted by corticotomy. In the CMG, surgical procedures consisted in an incision in the palatal, reaching from the mesial to the distal regions of the maxillary right first molar. Tooth movement in the MG and CMG was applied with coil spring force of 40 gF from the maxillary right first molar to the maxillary right incisor. The rats were sacrificed at days 1, 3, and 7, and histological sections were performed to evaluate the counting of osteoblasts and osteoclasts throughout the areas of tension and pressure. Result Histological analysis showed that the CMG presented better cell response to bone neoformation compared with that of the other groups. Greater proliferation of osteoclasts was observed in areas of pressure on day 3, resulting in increased reabsorption, whereas greater proliferation of osteoblasts was observed in areas of tension on day 1, indicating increased bone formation. Conclusion Differences between the treated groups occurred only in the initial period of tooth movement. Therefore, the changes caused by corticotomy are not significant in orthodontic movement to justify this invasive procedure.

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