Successful surgical treatment of intractable post-radiation rectal bleeding

Patients will typically present symptoms of chronic post-radiation colitis and proctitis 8-12 months after finishing their treatment. Endoscopic methods play the main role the treatment of bleeding caused by post-radiation colitis and proctitis. Surgical treatment is required for remained approximately 10% of patients. Here we present a 64 year old female with metastatic breast cancer, who was referred to us for intractable rectal bleeding. Total colonoscopy and rigid rectosigmoidoscopy revealed proctitis, rectal and sigmoidal telangiectasis, multiple necrotic ulcers between 15 to 30 cm from the anal verge, and also huge ishemic ulcer with patchy necrotic areas about 10 cm from the anal verge. This abnormal irradiated part was resected and then mucosectomy of the remnant rectum, both transabdominally and transanally was done. We performed pull-through technique of normal proximal colon to anal region through the remnant rectal wall and finally did coloanal anastomosis. Diverting stoma was not made because of anastomosis in anal region. With this technique we can achieve benefits such as avoidance of harsh dissection in a frozen pelvis and its consequences, we can avoid intra-abdominal anastomosis, there is no need to a diverting stoma and, most important of all, definite bleeding control.

A new cockroach (Blattodea, Corydiidae) with pectinate antennae from mid-Cretaceous Burmese amber

A new species of fossil cockroach, Fragosublatta pectinatagen. et sp. nov., is described from mid-Cretaceous Burmese amber. The new species is assigned to the family Corydiidae based on the following combination of characters: pronotum with tubercles, tegmina obovate with smallish anal region and spinules on the antero-ventral margin of the front femur (type C1). The new species is the second reported cockroach with ramified antennae. This finding broadens the diversity of Blattodea in mid-Cretaceous Burmese amber and provides further evidence of convergent evolution for antennal structures among different insect lineages.

Amplification of cestode DNA from the peri-anal region of naturally infected foxes by PCR and LAMP: proof of concept for a potential sampling strategy for diagnosing human taeniosis

The diagnosis of human taeniosis can be achieved through coproscopy, ELISA or PCR. An important limitation of these methods is the high turnaround time for stool sample collection and preparation, indicating the need for a straightforward sampling strategy. Due to the high metabolic activity and reproductive potential of Taenia spp., we hypothesise that parasite DNA (cells and eggs) present in the peri-anal region of the host can be exploited as a target for molecular diagnosis. We evaluated the feasibility of recovering parasite DNA from the peri-anal area of foxes naturally infected with Taenia spp. Before necropsy, cotton swabs were rubbed at the peri-anal region of foxes. DNA was extracted using alkaline lysis coupled with a commercial DNA isolation kit (method A) or alkaline lysis alone (method B). DNA was used in the multiplex-PCR assay (previously described and called here swab-PCR) and a novel LAMP assay detecting Taenia spp. commonly found in foxes (swab-LAMP). The results of these assays from 105 foxes were compared with the presence of intestinal helminths determined at necropsy and by the sedimentation and counting technique (SCT). The sensitivity of swab-PCR for detecting Taenia (n = 68) was 89.8% (95% CI, 77.7–96.6) and 89.5% (66.9–98.7) using methods A and B, respectively. The sensitivity of the swab-LAMP assay was 83.7% (70.3–92.7) using method A and 89.5% (66.9–98.7) with method B. We postulate that peri-anal swab sampling followed by simplified DNA extraction and LAMP might be a suitable strategy for surveillance of human taeniosis in resource-limited settings in the future.

EVALUATION OF EFFICACY OF DARUHARIDRA CHANDANA MALAHARA LEPA AND PANCHAVALKALA MALAHARA LEPA IN PARIKARTIKA WITH SPECIAL REFERENCE TO ACUTE FISSURE IN ANO

Background: Parikartika (Fissure-in-ano) is a clinical condition enrolled with the Laxana’s like Kartanavat (cut- ting type of pain) and Chedanavat Shoola in the anal region and it can be correlated with Anal Fissure associated with Pain, Burning sensation during Defecation and tear in the distal Anal Canal. The Incidence rate of Anal Fis- sure is around 1 in 350 adults they occur equally common in men and women and most often occurs in adults aged 15 to 40. Aims and Objectives: To compare the Efficacy of Daruharidra Chandana Malahara with Pan- chavalkala Malahara in the Management of Parikartika (Acute fissure in ano). Materials and Methods: For the Present study, cases were selected from OPD and IPD of Shalya Tantra with the Classical Clinical Features like Kartanvat and Chedanavat Shoola in the anal region. Intervention: Daruharidra Chandana Malahara Lepa and Panchavalkala Malahara Lepa, applied Locally into Two Groups with each Group having 20 Patients for 7 days along with Triphala Choorna (1tsp) HS. Results: Copesetic Relief was seen in Signs and Symptoms and Im- proved Quality of Life after Treatment. Conclusion: The Study Was Proved that Parikartika was Effectively Managed by Daruharidra Chandana Malahara Lepa comparatively Panchavalkala Malahara Lepa. Keywords: Parikartika, Fissure-in-ano, Daruharidra Chandana Malaharal Lepa, Panchavalkala Malahara Le- pa.

Non-mucinous adenocarcinomas and squamous cell carcinomas of the anal region masquerading as abscess or fistula: a retrospective analysis and systematic review of literature

Purpose Abscess or fistula of the anal region is an uncommon presentation of malignancy. Under the assumption of a benign condition, diagnostics is often delayed, resulting in advanced tumour stages at first diagnosis. Due to the case rarity, treatment guidelines for cancers of anorectal region masquerading as abscess or fistula are missing. Methods We analysed all patients presenting with an abscess or fistula of the anal region in our department between January 2004 and August 2020. The malignancies were included to our study to acquire data on clinical presentation, treatment and outcome. Furthermore, a systematic review to present adenocarcinomas and squamous cell carcinomas associated to an abscess or fistula was performed. Results 0.5% of the patients treated for an abscess or fistula of the anal region met the selection criteria. Mean time from the onset of symptoms to diagnosis of malignancy was 100 days. Histology revealed adenocarcinoma and squamous cell carcinoma each in two patients. All patients had locally advanced tumours without distant metastases, in two cases with regional lymph-node metastases. Neoadjuvant chemoradiation was applied in two patients. All patients underwent abdomino-perineal resection of the rectum. The overall outcome reveals a recurrence-free survival of 4.5 and 3 years for two patients. Further two patients died within 5 months after the primary resection. Conclusion Advanced carcinomas of the anorectal region may masquerade as abscess or fistula, cause diagnostic problems and delay oncologic treatment. However, even in these very advanced situations, surgical therapy with curative intent should be attempted.

CLINICAL ASSESSMENT OF A LOCAL APPLICATION OF KASISADI GHRITAIN PARIKARTIKA (FISSURE-IN-ANO)

Parikartika is charecterised by sharp cutting pain in the anal region. In parikartika teevrashoola, bleeding is observed, equally extreme pain slimy blood discharge are seen in fissure-in-ano. To test the efficacy of thelocal application of kasisadi ghruta in managing. Classical signs and symptoms of parikartika (fissure in ano) age groups of 20 to 60 years have been recruited for the research. The trial group obtained treatment with kasisadi ghruta local application for 28 days, twice a day. Average relief observed was observed 62.5% for most symptoms shothahara, vedanasthapana, and ropana are in kasisadi ghruta. Properties because of which it helps in healing the ano fissure.

An unusual presentation of foreign body rectum

Retrieval of rectal foreign body (FB) is a surgical dilemma. Variables including FB size, shape, make, time of insertion, presentation in ER, associated injuries, local edema, contamination, reluctance to seek medical aid, multiple unsuccessful attempts for self-retrieval masked by improper history and concealing the actual facts makes surgical management challenging. In this study, two unusual cases of FB in rectum and retrievals were presented. Case 1 was a 22 year old boy with a metallic glass tumbler in rectum reported after 12 days with constipation and pelvic pain. Repeated self-attempts for removal by the patient further pushed the FB upwards. Retrieval of rectal FB was done from rectum with repair and diversion colostomy which was closed later. Patient confessed this was his thirteenth attempt with the same object with successful retrieval all the time in last nine months. Case 2 was a 27 year old boy who inserted a sharp iron rod (used for picking ice) in the anal region which migrated to sigmoid colon without perforation of the viscera. Patient reported after three days with sharp shooting pain in left lower abdomen which aggravated on defecation. Abdominal examination revealed no sign of peritonitis, X-ray and CECT abdomen unexpectedly revealed no viscera perforation. Retrieval of FB stuck at sigmoid colon was undertaken with repair and diversion colostomy and closed later. From the study it was concluded that the retrieval of FB with proper psychological evaluation along with rehabilitation of the patient in society was a multidisciplinary management. Actual algorithm of management of these cases was beyond the surgical clinics and one-time emergency FB retrievals.

Calcinosis Cutis with Large Extension and Uncommon Location in a Dog

Background: Calcinosis cutis is an uncommon dermatopathy characterized by the deposition of minerals in the skin, usually involving collagen and elastic fibers in the dermis. Usually, it results from dystrophic calcification and can be generalized or focal. The dermatopathy may be primary or secondary to certain disorders, especially chronic proliferative otitis, foreign body reactions, hyperadrenocorticism (HAC) and less frequently percutaneous penetration of calcium-rich products. The aim of this report is to describe a presentation of calcinosis cutis affecting the skin of the back, internal face of hind limbs and anal region of a 9-year-old bitch.Case: A 9-year-old, non-defined breed, bitch, ovariohysterectomized, weighing 9.45 kg, was attended at the Dermatological Service of companion animals at the Veterinary Hospital of the Federal University of Jataí (UFJ). The animal came in with the complaint of extensive dorsal alopecia, covered by firm lesions, with a 3-month evolution, additionally to polyuria and polydipsia. After physical examination, alopecic areas of great extension were confirmed on the dorsum, on the internal surface of the hind limbs and in the anal region. Also, an exudative and painful lesion located on the back was detected, plus loss of elasticity of the ventral abdomen skin and visible abdominal vessels. The screening tests showed a marked increase in the alanine aminotransferase enzyme (ALT), alkaline phosphatase (ALP) and total cholesterol. The specific urinary density was decreased. On the ultrasound examination, hepatomegaly and an increase in the caudal pole of the left adrenal were detected. Based on these findings, calcinosis cutis secondary to spontaneous hyperadrenocorticism (HAC) was suspected. For confirmation, skin biopsy and low dose dexamethasone suppression test (LDDS) were performed. LDDS test showed no reduction of serum cortisol after 8 h of dexamethasone dose administration and histopathological evaluation revealed multiple foci of calcinosis characterized by the deposition of basophilic material on the pre-existing collagen fibers, plus areas with pyogranulomatous inflammatory reaction and peripheral fibrosis with transepidermal elimination of minerals. Thus, trilostane and intense hydration of skin plaques were applied as treatment.Discussion: The dermatological alterations were compatible with those described in the consulted literature, with remarkable yellow-brown, firm, sandy-looking plaques, located on the back, internal face of hind limbs and anal region, possibly related to HAC later confirmed by LDDS test and biopsy. The management of the underlying disease and possible secondary bacterial infections are the basis of treatment. Therefore, the patient was treated with trilostane, antibiotic therapy and intensive hydration of the mineralized plaques resulting in a satisfactory involution of the clinical signs. Even though there are reports of calcinosis cutis on the dorsum, in the consulted literature there was no evidence of dorsum large extension lesion due to HAC as in this case report, but secondary to exogenous corticosteroid treatment, systemic blastomycosis and leptospirosis. In this case report, the affected thorax portion was the dorsum, differently from a study that pointed the ventral thorax as the affected portion. Similarly, anus and ventral part of the tail were hardly affected together with secondary inflammation and ulceration. Thus, the existent literature shows areas of calcinosis cutis in dogs in different parts of the body, but neither extensive as in the back of this reported female dog, nor widely affected as in the anal area, additionally to the internal face of hind limbs as already reported in the literature.

Chakramarda Ghrita & Go-Ghrita in the management of Parikartika (fissure in ano): An Ayurvedic management protocol for the treatment of fissure

Anal Fissure is one of the significant causes of pain in the anal region. The two primary signs of this disease are pain and bleeding, and pain is often unbearable. In males, anal fissure typically occurs in the midline posterior- 90 %, and 10 % midline anterior. Subsequently, female fissures on the midline anteriorly are significantly more frequent than posteriorly (60:40). In contemporary sciences, Parikartika can be correlated with Fissure in Ano. The objective of the prospective study is to find the effectiveness of Chakramarda Ghrita & GoGhrita in the management of Parikartika. The present study is designed as a randomized, single-blind parallel in which 30 patients will be enrolled. Ghrita will be applied for local application twice a day. Assessment will be done 0th, 7th day, 14thday, and 28th day. The changes are expected to be observed in subjective parameters such as pain bleeding per rectum with itching as well as with objective parameters such as Parikartika Healing and tenderness. The study is expecting the non-surgical management of fissure in ano concerning the impact of Chakramarda Ghrita & GoGhrita. The research is expecting to be baseline and benchmark of the prospective studies in Parikartika.

MANAGEMENT OF PERINEAL AND PERIANAL WARTS THROUGH AYURVEDA: A CASE REPORT

Warts are the commonest benign, viral condition found in day to day practice and it is more common in young females. In Ayurveda warts may be compared with Charmakeel. As per Acharya Sushruta Agnikarma has been described as superior para-surgical procedures among all the measures used in Ayurveda, as the disease treated by it usually did not relapse. In present case report 33 years old female patient visited in Outpatient department (OPD) of Shalya Tantra having complaints of numerous growths in perineal and peri-anal region with itching and occasional pain since 6 months. The swelling was gradually increasing in size with local itching and discomfort. So the case was diagnosed as external genital warts and Chedana (excision) of the warts with cautery was planned. Orally two tablets (500mg each) Triphala Guggulu thrice in a day with luke warm water was advised for one month. Daily cleaning with Panchavalakal Kwath and dressing with Thumari Taila was performed till complete healing of the post-operative wound. Within 3 weeks wound was healed completely. Follow-up was done up to 10 months and patient had no any complaints or recurrence of warts. This case demonstrates that warts can be managed through Ayurveda without any complications, no recurrence and cost-effectively.