Polypropylene suture as a seton in recurrent fistula-in-ano in lower socioeconomic class-a good option

Background: Recurrent anal fistulas after previous fistula surgery are a unique problem that typically necessitates more anal surgical experience to address the cause of recurrence. The present study was planned with the objective to determine the outcomes of the polypropylene suture as a seton placement for the treatment of recurrent anal fistula.Methods: Patients between the ages of 20-80 years with recurrent fistula-in-ano with single external opening and with history of previous surgery. Patients with preoperative incontinence, patients with difficult follow-up and who were not ready to participate in the study, patients with fistulas caused by inflammatory bowel disease, malignancy, tuberculosis, or trauma, patients with a horseshoe or multiple fistulas, patients with recurrent fistula-in-ano with multiple external opening, or recurrent fistula-in-ano with diseases like Crohn’s disease, tuberculosis, actinomycosis, malignancy, or high level fistula-in-ano without internal opening, and patients with synchronous anorectal problems such as haemorrhoids were excluded.Results: Post-operative pain was observed in all patients while discharge, bleeding and inflammation were observed in 27, 10 and 8 patients, respectively on day 0. Majority of post-operative symptoms were resolves in almost all patients except, pain and discharge were observed in 2 and 1 patients, respectively on day 7. At 6 months follow-up, incontinence of flatus was found out in 2 patients while no patient had incontinence of faeces.Conclusions: Polypropylene suture as a seton in recurrent fistula-in-ano, in previously operated patient is safe and most acceptable treatment. Ksharsutra is not easily available but polypropylene suture is easily available.

Cooper’s syringocele (bulbourethral cyst)

Bulbourethral cyst or Cowpers syringocele (from the Greek syringe tube, cele expansion) is a cystic expansion of the excretory ducts of the bulbourethral glands (Cowpers glands). This disease is extremely rare and is more often diagnosed in the child population. The clinical manifestations of syringocele are non-specific and depend on many factors: size, localization, communication with the urethra, and the presence of an infectious component. Detection of syringocele is impossible without the use of special radiation and endoscopic diagnostic methods. Most often, this pathology is masked under inflammatory diseases of the genitals due to the fact that the symptoms are limited to secretions from the external opening of the urethra, changes in the general analysis of urine and dysuric manifestations. Currently in the domestic and foreign literature there are not even 20 publications devoted to this pathology.

Relationship between plasma concentrations of estradiol-17β and progesterone and the distribution of epithelial and inflammatory cells in the external opening of the river buffaloes’ uterine cervix during the gestational period

Changes in the distribution of the epithelial and inflammatory cells in the external opening of the uterine cervix in river buffaloes at three different occasions during the gestation period were investigated by light microscopic evaluation of mucus smears prepared by wet swab sampling and Giemsa-stained. Forty five pregnant river buffaloes that were in the first (n=15), second (n=15) and third (n=15) approximately equal parts of their gestation period were sampled twice concurrently by individual wet swabs from the external opening of the uterine cervix. Five smears were prepared from each sample. Immediately after mucus sampling, blood samples were obtained from the jugular vein of each animal, centrifuged immediately and stored at -20 oC to assay the plasma levels of estradiol-17β and progesterone. The results showed that changes in the percentage of the vacuolated and non-vacuolated epithelial cells, lymphocytes, eosinophils, and basophils were not statistically significant between the groups, which suggests that as the pregnancy progressed, changes in the blood levels of estradiol-17β and progesterone had little or no effect on the distribution of these cells in the region, but changes in the percentage of neutrophils were statistically significant between the groups. It was also found that changes in the percentage of macrophages between the second and third trimesters of the gestation period were not significant, but the difference between the first and the other trimesters was statistically significant. It was concluded that the percentages of neutrophils and macrophages increase significantly as the plasma concentrations of progesterone decrease during the gestation.

Goodsall’s rule– its predictive accuracy in tracing the tract of fistula in ano

Background: Despite being one of the oldest reported medical conditions, the management and treatment of fistula in ano are still in the evolving phase. The management of fistula-in-ano requires confirmation of the diagnosis, identifying the fistulous tract and inner opening. In majority of patients a single primary fistula tract exists and the anatomy can be determined by examination under anaesthesia adhering to the principles described by Goodsall. A thorough clinical examination of the patient is essential in the assessment of fistula-in-ano, sometimes helped by imaging such as magnetic resonance imaging and endoanal ultrasonography. Although Goodsall’s rule was accepted in the past, as a method to determine the course of the fistula, recent studies showed poor conflicting results. Thus, this study attempts to scrutinize the predictive accuracy of Goodsall’s rule. Methods: After approval from ethical committee and obtaining informed consent from each patient, prospective analysis of 188 patients who has fistula-in-ano were included in the study. They were grouped according to Goodsall’s rule and its predictive accuracy was checked with intraoperative findings. Data was entered in excel sheet and analysed by SPSS version 20.0. For all statistical interpretations, p<0.05 was considered the threshold for statistical significance.Results: Predictive accuracy of Goodsall’s rule found to be 84.6% in case of fistula with an anterior external opening. While in case of fistula with posterior external opening this found to be 69.1%. Overall predictive accuracy of Goodsall’s rule is 77%. Conclusions: Goodsall’s rule can be used as guide in predicting the tract.

I. M. Lvov. Narrowing of the external opening of the cervix and its improvement in a simplified way Borissowicz'a. (Weekly, 1894, No. 29, p. 485)

Making a brief outline of the pathology of narrowing of the cervical drip, the author points out the narrowing of the external opening, as a common cause (96%) of infertility in women and as a cause, together with inflammatory changes in the neck, painful months. When reducing the contraction, the author often resorts to cutting the neck (Sims) and praises this method.

T. Boryssowicz. Stale rozszerzenie ujscia zewnetrirnego macicy, zapomoca przewiazania bocznych scian dolnego odcinka czesc pochwowej (Medycyna, 1893, no. 9). Persistent expansion of the external uterine opening by ligation of the lateral walls of the lower branch of the vaginal part (Dilatatio ostii externi uteri ope ligaturae)

Persistent expansion of the canal of the uterine cervix in order to cure infertility or painful months began to be applied even from the beginning of the past century. But all the methods of discisionis portionis vaginalis proposed so far leave a lot to be desired and, according to Schroeder, produce either too little or excessive enlargement of the external opening, always disfiguring the vaginal part.

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

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.