Anal canal mixed adenoneuroendocrine carcinoma in a young patient misdiagnosed as anal abscess

Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) are rare tumours of gastrointestinal tract, extremely rare in anal canal. We report a case of misdiagnosed MiNEN in a 38-year-old woman initially conservatively treated for a supposed anal fistula. In a second proctological evaluation, biopsy of the anal neoformation was performed and the histological specimen diagnosed a MiNEN. The complete staging showed a disseminate disease and the patient started a chemotherapy schedule. After 6 months, stable disease was revealed at the last imaging performed and radical surgery was offered to the patient that is actually on oncological follow-up without recurrence at 1 year.

AshwathaKsheer Sutra and UdumberKsheer Sutra in the management of Bhagandara (Fistula in ano): An Ayurvedic management protocol for treatment of fistula in ano

Fistula in ano is tract lined by granulation tissue having internal opening in anal canal and rectum and external opening in the perianal region. The incidence of a fistula-in-ano developing from an anal abscess ranges from 26-38%. The prevalence of non-specific anal fistula has been estimated to be 8.6 to 10/100,000 of the population per year, with a male to female ratio of 8:1.in contemporary sciences Bhagandara can be correlated with Fistula in Ano. To compare the efficacy of AshwathaKsheer Sutra and UdumberKsheer Sutra in the management of Bhagandara (Fistula in ano). The present study is designed as a Randomized single blind parallel in which 40 patients will be enrolled. Patients will be distributed in two group with 20 patients in each group. In group A AshwathaKsheerSutra and in group B UdumbarKsheerSutra will be changed after 7 days till the cure of fistula. Assessment of the patients will be done on day 1st, 8th, 15th, and 22nd after intervention, follow up will be taken on 29th day. Results will be drawn from the observations of objective parameters. Conclusion of the study will be drawn on the basis of statistical data calculated from the collected data.

Risk for developing perianal abscess in type 1 and type 2 diabetes and the impact of poor glycemic control

Purpose The primary aim of this study was to see whether perianal abscess rate differs between patients with type 1 and type 2 diabetes. A secondary aim was to determine whether poor glycemic control increases the risk for perianal abscess. Methods Data from the Swedish National Diabetes Registry and the Swedish National Patient Registry between January 2008 and June 2015 were matched. The risk for anal abscess was evaluated in univariate and multivariate analyses with type of diabetes, HbA1c level, BMI, and various diabetes complications as independent factors. Results Patients with type 1 diabetes had a lower rate of perianal abscess than patients with type 2 diabetes when adjusted for HbA1c, sex, and age (OR 0.65; 95% CI 0.57–0.73). The risk for perianal abscess increased with higher HbA1c. Incidence of perianal abscess was also elevated in diabetes patients with complications related to poor glycemic control such as ketoacidosis and coma (OR 2.63; 95% CI 2.06–3.35), gastroparesis, and polyneuropathy (OR 1.81; 95% CI 1.41–2.32). Conclusions The prevalence of perianal abscess was higher among patients with type 2 diabetes than those with type 1, suggesting that metabolic derangement may be more important than autoimmune factors. Poor glycemic control was associated with higher risk for perianal abscess.

Study the Incidence of Fistula- in- Ano in Subsequent to Anal Abscess

Background: The Fistula disease is considered common surgical case in the surgical wards of the Baquba teaching hospital, and consider as a complication of the anorectal abscess. Objective: To investigate the incidence of cases that infect with fistula in ano in subsequent to different types of anorectal abscesses. Patients and Methods: This study performed in the Baquba teaching hospital in a period from January 2016 until Jun 2018 including 216 patients (124 male and 92 female); all patients were included in the study . Samples of the patients classified into three groups according to the type of management. Results: The results show that the high incidence of fistula in ano is appearing in patients associated with hemorrhoids 8.84%, and high percent in patients who had a perianal abscess (63.48%) Regarding the distribution of cases according to age and sex, a low percentage of cases appear in age (1-10) with 6.45% and 2.18% in males and females respectively. While the highest percentage appears in the males at age (21-30) with 37.11% and in females is at the age (11-20) with 29.35%. And by the chi-square value for males is 16.37 and for females is 9.94 in a significant value of p=0.01 and p=0.05 respectively. Conclusion: Fistula in ano can be associated with cases have hemorrhois, and more present with patients who have a perianal abscess, and the early drainage of the abscess can prevent development of the fistula. Keywords: Fistula, Ano, Anorectal abscess, Internal anal sphincter

Dilemmák egy új kezeléssel remisszióba hozott AML-beteg esete kapcsán: a kezelés intenciójának változása

Összefoglaló. Az acut myeloid leukemia a csontvelői eredetű hemopoetikus őssejtek malignus klonális betegsége. A betegség lefolyása, különösen a nagy dózisú kemoterápiára és allogén csontvelő-transzplantációra alkalmatlan betegek számára, a legutóbbi időkig szinte kivétel nélkül fatális volt. Az idős és/vagy leromlott állapotú acut myeloid leukemiás betegek kezelésében óriási áttörést hozott a Bcl2- (B-cell lymphoma 2) inhibitor – venetoclax és a hypomethyláló azacitidin kombinációja. Ötvenéves nőbetegünkön a normál karyotípusú, nucleophosmin 1 mutációval járó acut myeloid leukemia diagnózisa előtt szeptikus állapotot okozó végbéltályog miatt tehermentesítő colostomaképzést végeztünk. A széles spektrumú kombinált antibiotikus kezelés mellett is súlyosan elesett, szeptikus állapotú betegen a nagy dózisú, kuratív indukciós kezelést nem tartottuk kivitelezhetőnek, ezért venetoclax–azacitidin kombinációt alkalmaztunk. A beteg az első ciklus alatt az antibiotikus, antimycoticus kezelés mellett masszív hemoszupportációra szorult. A második ciklus alatt lényeges szövődményt már nem észleltünk, a ciklus végén elvégzett csontvelővizsgálat pedig komplett hematológiai remissziót igazolt. A páciens önellátóvá vált, a végbéltályog jelentősen javult. Az új kezelési lehetőség mellett elért remisszió, a beteg javuló általános állapota korábban ismeretlen problémát vet fel. Egy 50 éves beteg jó prognózisú eltéréssel járó acut myeloid leukemiájának ellátása a nagy dózisú kemoterápiával elért első remisszióban nem igényel allogén csontvelő-transzplantációt. „Nem kuratív” kezeléssel elért remisszióban hogyan folytassuk a kezelést? Summary. Acute myeloid leukemia is a clonal malignancy of bone marrow haemopoietic stem cells. Until recently the outcome of the disease has been almost without exemption fatal, especially in cases ineligible for high dose induction chemotherapy and bone marrow transplantation. The Bcl-2 inhibitor venetoclax-azacitidine combination is a breakthrough therapy for the elderly and frail AML patient. Prior to the diagnosis of normal karyotype NPM 1 mutant AML of our 50-year-old female patient a colostomy had been performed due to anal abscess leading to sepsis. The septic patient being extremely frail in spite of wide spectrum antibiotic treatment was deemed ineligible for high dose curative induction treatment, hence venetoclax-azacitidine combined treatment was used. During cycle 1 the patient needed massive transfusion support beside concomitant antibiotic and antimycotic medication. On course of cycle 2 no major complications were detected, BM evaluation at the end of cycle confirmed complete haemotologic remission. The abscess significantly improved, the patient’s self-care capability was restored. The remission induced by this new option and the improvement of the performance status of the patient raised hitherto unasked questions. In case of a patient aged 50, a favourable prognosis AML in remission following high dose induction does not mandate HSCT as a next step. How shall we follow the course of treatment in remission elicited by a ‘non-curative’ option?

Analgesic effects of Mathan Thylam- A pharmacognostic review

Mathan Thylam is a medicated oil which is widely used as a topical medicine. In native of Siddha system, this oil is prescribed to heal all types of ulcers and wounds. It is very effective in curing severe carbuncle ulcer of diabetes, diabetic foot ulcers. The oil has a wide variety of other therapeutic topical applications such as eczema, bedsores itches, weeping eczema, wounds, folliculitis, anal fistula, ear infections, per anal abscess, alopecia, non-healing of cut and burns wounds. The vital compositions of the mathan thylam are constituted with thurusu (copper sulphate), datura leaf and coconut oil. These active ingredients, present in mathan thylam acts to play a major role in healing ulcers. In this study, we aimed to prove the analgesic effect of mathan thylam. As a result of the presence of datura leaf, mathan thylam can be used as an unsurpassed analgesic than any other medicated oils. This oil is used to reduce pain as well as inflammation. The Phytochemical and GCMS analysis of a hydroalcoholic extract of the mathan thylam revealed the presence of coumarin, steroid, alkaloid, saponin, furan, quinine and triterpenoid. This comprehensive review includes information on botany, phytochemistry, pharmacology and ethnomedical uses of datura, which is the key ingredient in mathan thylam to be used as a topical analgesic.