PURPOSE: This prospective study evaluated the efficacy and safety of local formalin application in chronic refractory radiation- induced hemorrhagic proctitis. METHODS: All patients were treated under anesthesia by di...PURPOSE: This prospective study evaluated the efficacy and safety of local formalin application in chronic refractory radiation- induced hemorrhagic proctitis. METHODS: All patients were treated under anesthesia by direct application of 4 percent formalin to the affected rectal areas. RESULTS: The study included 33 patients (17 women) and was conducted between January 1994 and December 2001. There were 11 anal cancers (33 percent), 11 prostate cancers, 9 cervical or endometrial cancers, 1 bladder cancer, and 1 rectal cancer. The mean number of daily rectal bleeds was 2.7 (range, 0.5- 15). Nineteen patients (58 percent) were blood transfusion dependent. Twenty- three patients had only one formalin application and 10 patients required a second application because of the persistent bleeding. The treatment was effective in 23 cases (70 percent): 13 patients had complete cessation of bleeding and 10 patients had only minor bleeding. Six anal or rectal strictures occurred: 4 patients had been treated for anal cancer (36 percent) and 2 patients had been treated for other cancers (9 percent). None of the strictures was malignant. Anal incontinence worsened in 5 patients of the 11 who had been treated for anal cancer (45 percent) and occurred in 4 of the 22 other patients (18 percent). CONCLUSION: Formalin application is an effective treatment for chronic radiation- induced hemorrhagic proctitis. However, local morbidity is not negligible. This result may be related to the high proportion of anal cancers in the series. In our opinion, therefore, formalin application should be reserved for severe hemorrhagic proctitis refractory to medical treatment and should be thoroughly discussed in cases of anorectal radiation- induced stricture, prior anal incontinence, or treated anal cancer.展开更多
Introduction - Primary anal actinomycosis of cryptoglandular origin, mainly due to Actinomyces israelii, a specific and rare cause of anal suppurative disease, needs to be recognized because it can be cured using spec...Introduction - Primary anal actinomycosis of cryptoglandular origin, mainly due to Actinomyces israelii, a specific and rare cause of anal suppurative disease, needs to be recognized because it can be cured using specific treatments. Method - Data were reviewed from 6 patients with actinomycotic anal Abscesses of obvious cryptoglandular origin observed in a single proctology unit between 1983 and 2000. Therapeutic management included conventional surgical treatment of anal sepsis followed by a specific oral antibiotic therapy maintained until the surgicalwound had completely healed. Results -All but one of the patients were men (median age, 53 years). All Abscesses, except one, were indolent. No patient presented macroscopic “ sulphur granules” in the pus, but one presented “ watery pus” . The diagnosis was established by histological study of the surgically excised tissue or by anaerobic culture of the pus. In the oneHIV-positive patient, an uncommon organismwas isolated: Actinomyces meyeri. Two cases of recurrence were observed without evidence of Actinomyces infection. Conclusion -Actinomycosis should be suspected particularly in indolent anal suppuration. The Absence of macroscopic “ sulphur granules” does not mean this diagnosis can be ruled out. Careful histological examination of the excised tissue and appropriate anaerobic cultures of pus should be carried out to achieve complete eradication of this rare, but easily curable disease.展开更多
Background: Transcranial ultrasound may be used to detect increased iron leve ls of the substantia nigra (SN) in patients with Parkinson disease (PD) and in c ontrol subjects. It is not known whether iron accumulation...Background: Transcranial ultrasound may be used to detect increased iron leve ls of the substantia nigra (SN) in patients with Parkinson disease (PD) and in c ontrol subjects. It is not known whether iron accumulation in PD is a primary or secondary phenomenon. However, sequence variations in genes involved in iron me tabolism have been linked to basal ganglia disorders. One of these is ceruloplas min (Cp), which is vitally involved in iron transport across the cell membrane. Methods: One hundred seventy-six patients with PD according to the UK Brain Ba nk criteria and 180 ethnically matched control subjects, who were previously exa mined for SN iron signal changes by transcranial ultrasound, were examined for m utations in the Cp gene using denaturing high-performance liquid chromatograph y and subsequent sequencing for verification of unequivocal signals. Immunohisto chemistry of PD midbrains was performed to examine the presence of Cp in Lewy bo dies. Results: Five novel missense variations were detected. One of these (I63T) was found in a single PD patient. A known variation (D554E)was significantly as sociated with PD and the ultrasound marker for increased SN iron levels. Moreove r, a third sequence variation (R793H) was found to segregate with the ultrasound marker for increased iron levels in patients an d control subjects. Immunohistochemistry demonstrated that Cp co-localizes wit h Lewy bodies in PD. Conclusions: Detection of sequence variations in a single P arkinson disease (PD) patient or associated with the ultrasound marker for incre ased substantia nigra iron levels and the presence of ceruloplasmin (Cp) immunor eactivity in Lewy bodies underline a suspected role for Cp in the pathogenesis o f PD. Further functional analyses are warranted to investigate whether these var iations are causally linked to the complex pathogenesis of PD in a subset of cas es.展开更多
文摘PURPOSE: This prospective study evaluated the efficacy and safety of local formalin application in chronic refractory radiation- induced hemorrhagic proctitis. METHODS: All patients were treated under anesthesia by direct application of 4 percent formalin to the affected rectal areas. RESULTS: The study included 33 patients (17 women) and was conducted between January 1994 and December 2001. There were 11 anal cancers (33 percent), 11 prostate cancers, 9 cervical or endometrial cancers, 1 bladder cancer, and 1 rectal cancer. The mean number of daily rectal bleeds was 2.7 (range, 0.5- 15). Nineteen patients (58 percent) were blood transfusion dependent. Twenty- three patients had only one formalin application and 10 patients required a second application because of the persistent bleeding. The treatment was effective in 23 cases (70 percent): 13 patients had complete cessation of bleeding and 10 patients had only minor bleeding. Six anal or rectal strictures occurred: 4 patients had been treated for anal cancer (36 percent) and 2 patients had been treated for other cancers (9 percent). None of the strictures was malignant. Anal incontinence worsened in 5 patients of the 11 who had been treated for anal cancer (45 percent) and occurred in 4 of the 22 other patients (18 percent). CONCLUSION: Formalin application is an effective treatment for chronic radiation- induced hemorrhagic proctitis. However, local morbidity is not negligible. This result may be related to the high proportion of anal cancers in the series. In our opinion, therefore, formalin application should be reserved for severe hemorrhagic proctitis refractory to medical treatment and should be thoroughly discussed in cases of anorectal radiation- induced stricture, prior anal incontinence, or treated anal cancer.
文摘Introduction - Primary anal actinomycosis of cryptoglandular origin, mainly due to Actinomyces israelii, a specific and rare cause of anal suppurative disease, needs to be recognized because it can be cured using specific treatments. Method - Data were reviewed from 6 patients with actinomycotic anal Abscesses of obvious cryptoglandular origin observed in a single proctology unit between 1983 and 2000. Therapeutic management included conventional surgical treatment of anal sepsis followed by a specific oral antibiotic therapy maintained until the surgicalwound had completely healed. Results -All but one of the patients were men (median age, 53 years). All Abscesses, except one, were indolent. No patient presented macroscopic “ sulphur granules” in the pus, but one presented “ watery pus” . The diagnosis was established by histological study of the surgically excised tissue or by anaerobic culture of the pus. In the oneHIV-positive patient, an uncommon organismwas isolated: Actinomyces meyeri. Two cases of recurrence were observed without evidence of Actinomyces infection. Conclusion -Actinomycosis should be suspected particularly in indolent anal suppuration. The Absence of macroscopic “ sulphur granules” does not mean this diagnosis can be ruled out. Careful histological examination of the excised tissue and appropriate anaerobic cultures of pus should be carried out to achieve complete eradication of this rare, but easily curable disease.
文摘Background: Transcranial ultrasound may be used to detect increased iron leve ls of the substantia nigra (SN) in patients with Parkinson disease (PD) and in c ontrol subjects. It is not known whether iron accumulation in PD is a primary or secondary phenomenon. However, sequence variations in genes involved in iron me tabolism have been linked to basal ganglia disorders. One of these is ceruloplas min (Cp), which is vitally involved in iron transport across the cell membrane. Methods: One hundred seventy-six patients with PD according to the UK Brain Ba nk criteria and 180 ethnically matched control subjects, who were previously exa mined for SN iron signal changes by transcranial ultrasound, were examined for m utations in the Cp gene using denaturing high-performance liquid chromatograph y and subsequent sequencing for verification of unequivocal signals. Immunohisto chemistry of PD midbrains was performed to examine the presence of Cp in Lewy bo dies. Results: Five novel missense variations were detected. One of these (I63T) was found in a single PD patient. A known variation (D554E)was significantly as sociated with PD and the ultrasound marker for increased SN iron levels. Moreove r, a third sequence variation (R793H) was found to segregate with the ultrasound marker for increased iron levels in patients an d control subjects. Immunohistochemistry demonstrated that Cp co-localizes wit h Lewy bodies in PD. Conclusions: Detection of sequence variations in a single P arkinson disease (PD) patient or associated with the ultrasound marker for incre ased substantia nigra iron levels and the presence of ceruloplasmin (Cp) immunor eactivity in Lewy bodies underline a suspected role for Cp in the pathogenesis o f PD. Further functional analyses are warranted to investigate whether these var iations are causally linked to the complex pathogenesis of PD in a subset of cas es.
