Ambulatory Surgery for Perianal Disease

The gold standard in the diagnosis and treatment of proctological diseases is the exploration of the anal canal and distal rectum under anaesthesia (EUA), routinely performed as day case surgery. In selected cases it can be conducted as an outpatient exploration (OE) during a specialist surgical consultation. In the outpatient setting it is possible and safe to perform rubber band ligation, sclerotherapy and infrared coagulation for the treatment of haemorrhoidal disease, excision and incision of thrombosed external haemorrhoids, abscess drainage, setonage and fistulotomy also in case of perianal Crohn’s disease, anal warts and skin tags removal. In terms of patients’ satisfaction and success rate OE is comparable to EUA. All procedures can be performed under local anaesthesia. Pain control after the procedure is provided by oral pain killers.

Rectum and anus

The rectum and anus chapter explains diseases and conditions of the rectum and anus. The diseases of the rectum and anus are explored with the common presenting symptoms identified. The occurrence rates of these conditions are defined and any potential causes listed. The investigations that are required to diagnose the conditions are described. Treatment options or preventative measures are also explained with identification of any potential complications. There are many conditions that can affect the rectum and anus including rectal prolapse, haemorrhoids, pilonidal sinus, and rectocele. Other conditions include anorectal abscess, anal fistula, anal warts, and anal fissure. Succinct descriptions of caring for people with diseases and conditions of the rectum can increase the knowledge of the nurse.

Secondary syphilis presenting as erythema multiforme in a HIV-positive homosexual man: a case report and literature review

Early syphilis can rarely cause erythema multiforme-type eruptions as well as triggering erythema multiforme (EM). EM-like lesions in secondary syphilis are characterized by clinical features of EM and laboratory tests consistent with secondary syphilis and the skin histology shows predominantly a plasma cell infiltrate with the presence of treponemes. When EM is triggered by early syphilis, the skin histology shows mixed inflammatory cells usually in the absence of treponemes in the skin lesion. There may also be mixed histology with the presence of treponemes in the absence of a plasma cell infiltrate and vice versa. We describe a case of secondary syphilis presenting as EM with bullae and histology showing EM features without a plasma cell infiltrate but positive for Treponema pallidum by immunohistochemical staining. The patient was also coinfected with cytomegalovirus, human immunodeficiency virus, and anal warts. The EM eruptions resolved with treatment for secondary syphilis with benzathine penicillin G.

A clinical study on genital warts and HIV in Bangladesh

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Like other sexually<strong> </strong>transmitted diseases (STD), ano-genital warts (AGW) is associated with human immunodeficiency virus (HIV) infection and this study of AGW was conducted among HIV positive and HIV negative patients. The aim of the study was to study the risk factors and clinical presentations of ano-genital warts in HIV infected patients</span>.</p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A comparative, cross-sectional, descriptive study of 25 HIV positive and 25 HIV negative (n=50) AGW patients between 15-60 years of both sex was conducted in Northern part of Bangladesh from July 2015 to December 2016. </span><span lang="EN-IN"> </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Significant association of HIV positivity (p&lt;0.05) was<strong> </strong>observed between age group of 15-30 years and HIV negative status (p&lt;0.05) in age group of 31-45 years. HIV positive status significantly higher in patients with self-admitted multiple sexual partners (p&lt;0.01), homosexuality (p&lt;0.05) and presentation with anal warts (p&lt;0.01). HIV negative status correlated significantly with single sexual partner admission (p&lt;0.01) and hetero-sexuality (p&lt;0.05). Gender did not show significant association with number of sexual partners or HIV positivity. Extra-genital or only genital warts had no association with HIV status. Co-STDs though more in number in seropositive group, did not show any significant association with HIV positivity (p&gt;0.05). No patient presented with changes of malignancy. Four were adolescents below 19 years. Two patients had atypical presentations of giant condylomata i.e., Buschke-Lowenstein tumour (BLT)</span>.</p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">HIV positivity was significantly associated with<strong> </strong>the risk factors of age below 30 years, homo sexuality and multiple sexual partners. Anal warts were significantly common in HIV positive patients. Four adolescents with AGW underline the need for high risk behaviour counselling. No patient had malignant AGW. Follow up of these patients with human papilloma virus (HPV) sub-typing is necessary. </span></p>