Significance and Impact of the Intersphincteric Plane Sepsis in the Management of the Perianal Sepsis: Ultrasound Study

Background The intersphincteric plane (ISP) is a potential space between the external and the internal anal sphincters. About 90% of the perianal sepsis is caused by an obstruction of the ducts of anal glands with subsequent secondary bacterial infection. The imaging modalities used to diagnose perianal sepsis are the ultrasound via endoanal and transperineal routes and magnetic resonance imaging. Objective The study aimed to identify the various patterns of the ISP sepsis and their incidence among our study group and to clarify the significance of ISP in the pathogenesis of anorectal abscesses and various types of perianal fistula tracts, to optimize the surgical management. Methods Retrospective descriptive study in which 57 patients with an ISP sepsis were evaluated with full medical history, clinical exam, and ultrasound; the final diagnosis was based on combining the results of ultrasound, digital rectal examination under anesthesia, and the operative results. Results The current study showed many patterns of the ISP sepsis and estimated the incidence of each pattern among our study group; such patterns could be fistula tracts, sinus tracts, abscesses, intersphincteric abscess with supralevator extension, sinus with abscess formation, fistula with abscess formation, distension of the ISP with free pus, and other complex patterns like horse abscess, abscess with transsphincteric sinus, and ISP fistula/sinus with transsphincteric branches. Conclusion Understanding the role of the ISP in the pathogenesis of anorectal abscesses and perianal fistula tracts can help in reaching the optimum way of management.

PECULIARITIES OF DIAGNOSTICS AND TREATMENT OF PARAPROCTITIS IN CHILDREN

Relevance. Children with acute and chronic paraproctitis constitute 1-3% of hospitalized subjects with purulent surgical infection. Purpose. To study specific features of paraproctitis in children and to analyze outcomes of treatment. Material and methods. Case-histories of 218 children with acute and chronic paraproctitis were analyzed. Microbiological culture for pathogen identification was taken from paraproctitis focus, breast milk, from feces for conditionally pathogenic flora. The researchers also studied anamnesis, type of feeding, results of ultrasound examination of the perianal area and histological test of the material taken during surgery. Results. Patients with subcutaneous and subcutaneous-submucous paraproctitis constituted 95.5% [1]. The majority of patients with subcutaneous and subcutaneous-submucous paraproctitis - up to 62,5% - were children of the first 6 months of their life. The researchers defined age and etiopathogenic aspects of paraproctitis in children; the impact of provoking factors at acute paraproctitis as well as the specificity of chronic paraprocitis course and its treatment. 76 patients with acute paraproctitis had bottle and mixed feeding for the first 6 months of their life with further developed intestinal dysbiosis. In 112 children, conditionally pathogenic microorganisms were identified in 91 (81,2%) at the first year of their life. Ultrasound examination was sensitive for acute and chronic paraproctitis in about 90% [2, 3]. With the developed intestinal dysbiosis and immunological features of children at their first year of life , the process of acute paraproctitis was caused by the causal anal crypt and abnormal ducts of anal glands. It is considered to be the first step in fistula formation (fistulous abscess) [4-6]. The Gabriel surgery performed in acute paraproctitis was pathogenically verified because due to it one of the pathogenic steps was erradicated- pararectal fistula formation [7-11]. Disease relapse (pararectal fistula) was met in 7 patients. In average, hospitalization lasted for 7.1 days in acute paraproctitis and 8.4 in chronic paraproctitis. Conclusion. On analyzing etiopahogenic features of acute subcutaneous and subcutaneous-submucous paraproctitis, the authors recommend to perform a one-step surgical intervention.

The anal secretory apparatus of Eriophyoidea and description of Phyllocoptes bilobospinosus n. sp. (Acariformes: Eriophyidae) from Tamarix (Tamaricaceae) from Ukraine, Crimea and USA

A new vagrant phyllocoptine species, Phyllocoptes bilobospinosus n. sp. (Eriophyidae, Phyllocoptinae), found on tamarisks (Tamarix tetrandra Pallas, T. smyrnensis Bunge, T. ramossisima Ledeb) in Donbass (Ukraine), Crimea, and USA is described based on conventional light microscopy and confocal laser scanning microscopy. Apart from two distinct areas of ventral cuticle bearing large, spike-like microtubercles, the new species possesses a thin translucent supracapitular plate (situated below the frontal lobe of the prodorsal shield), a short longitudinal ventral ridge anterior to the anal lobes, and unusual internal tube-like structures associated with the rectum. Careful examination of purposefully made slide mounts of partially cleared specimens revealed that adults of P. bilobospinosus possess a complex of structures associated with the rectum, including a hypertrophied, four-lobed putative anal gland and four thin tubes connected with a rectal sac. Similar tubular structures previously described in aberoptine mites of the genus Aberoptus from Brazilian Cesalpiniaceae are discussed. The synonymy of genera Aberoptus Keifer and Aceria Keifer is rejected and a new combination, Aberoptus inusitatus (Britto & Navia (in Britto et al. 2008)) n. comb., is proposed. A brief review of the anal glands of Eriophyoidea is given, including a discussion on homology and the variety of forms of the anal secretory apparatus among eriophyoid genera. Further research is needed on the anatomy of anal glands in Eriophyoidea, including transmission electron microscopy based histological analyses and additional studies of eriophyoids with well-developed secretory structures associated with the rectum. These methods will lead to a much better understanding of the evolution and homology of the anal secretory apparatus, which may render it useful for future phylogenetic studies.

Blattes de Byzance in India: Mollusk Opercula and the History of Perfumery

Aromatics derived from animals have played a very important role in the history of perfumery. The most well-known of these materials are musk from the preputial glands of the musk deer, ambergris produced in the stomach of the sperm whale, and civet from the anal glands of the civet cat. Two other notable materials are castoreum from the beaver, and hyraceum from the solidified urine of the African hyrax. The material that I will call ‘sweet hoof’ in this article, also called blattes de Byzance and unguis odoratus, is another fragrant material derived from an animal, consisting of the opercula of certain marine snails. With its marine origins ‘sweet hoof’ is intrinsically linked to the ocean and to trade, and it has also long been of importance all the way from the Mediterranean to China and Japan. Indeed, it is probably the most ancient animal derived aromatic to have an extensive global use, being mentioned in ancient Babylonian incense recipes. Yet, quite probably owing to its very low profile in more commonly studied genres of Sanskrit texts, the South Asian chapter of the history of ‘sweet hoof’ has yet to be written.