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  • Diagnosis and Treatment of Perianal Crohn Disease: NASPGHAN Clinical Report and Consensus Statement
    CLINICAL REPORT Diagnosis and Treatment of Perianal Crohn Disease: NASPGHAN Clinical Report and Consensus Statement ÃEdwin F. de Zoeten, zBrad A. Pasternak, §Peter Mattei, ÃRobert E. Kramer, and yHoward A. Kader ABSTRACT disease. The first description connecting regional enteritis with Inflammatory bowel disease is a chronic inflammatory disorder of the perianal disease was by Bissell et al in 1934 (2), and since that time gastrointestinal tract that includes both Crohn disease (CD) and ulcerative perianal disease has become a recognized entity and an important colitis. Abdominal pain, rectal bleeding, diarrhea, and weight loss consideration in the diagnosis and treatment of CD. Perianal characterize both CD and ulcerative colitis. The incidence of IBD in the Crohn disease (PCD) is defined as inflammation at or near the United States is 70 to 150 cases per 100,000 individuals and, as with other anus, including tags, fissures, fistulae, abscesses, or stenosis. autoimmune diseases, is on the rise. CD can affect any part of the The symptoms of PCD include pain, itching, bleeding, purulent gastrointestinal tract from the mouth to the anus and frequently will include discharge, and incontinence of stool. perianal disease. The first description connecting regional enteritis with perianal disease was by Bissell et al in 1934, and since that time perianal INCIDENCE AND NATURAL HISTORY disease has become a recognized entity and an important consideration in the Limited pediatric data describe the incidence and prevalence diagnosis and treatment of CD. Perianal Crohn disease (PCD) is defined as of PCD. The incidence of PCD in the pediatric age group has been inflammation at or near the anus, including tags, fissures, fistulae, abscesses, estimated to be between 13.6% and 62% (3).
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  • Plugs for Anal Fistula Repair Original Policy Date: November 26, 2014 Effective Date: January 1, 2021 Section: 7.0 Surgery Page: Page 1 of 12
    Medical Policy 7.01.123 Plugs for Anal Fistula Repair Original Policy Date: November 26, 2014 Effective Date: January 1, 2021 Section: 7.0 Surgery Page: Page 1 of 12 Policy Statement Biosynthetic fistula plugs, including plugs made of porcine small intestine submucosa or of synthetic material, are considered investigational for the repair of anal fistulas. NOTE: Refer to Appendix A to see the policy statement changes (if any) from the previous version. Policy Guidelines There is a specific CPT code for the use of these plugs in the repair of an anorectal fistula: • 46707: Repair of anorectal fistula with plug (e.g., porcine small intestine submucosa [SIS]) Description Anal fistula plugs (AFPs) are biosynthetic devices used to promote healing and prevent the recurrence of anal fistulas. They are proposed as an alternative to procedures including fistulotomy, endorectal advancement flaps, seton drain placement, and use of fibrin glue in the treatment of anal fistulas. Related Policies • N/A Benefit Application Benefit determinations should be based in all cases on the applicable contract language. To the extent there are any conflicts between these guidelines and the contract language, the contract language will control. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. Some state or federal mandates (e.g., Federal Employee Program [FEP]) prohibits plans from denying Food and Drug Administration (FDA)-approved technologies as investigational. In these instances, plans may have to consider the coverage eligibility of FDA-approved technologies on the basis of medical necessity alone.
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  • Jebmh.Com Original Research Article
    Jebmh.com Original Research Article URETERIC STRICTURES AN ANALYTICAL STUDY OF AETIOLOGY, PATHOLOGY AND MANAGEMENT Saju P. R1, Rema Priyadarsini2, Vaibhav Vikas3, Praveen Gopi4, Rustum Singh Kaurav5 1Additional Professor, Department of Urology, Trivandrum Medical College, Trivandrum. 2Additional Professor, Department of Pathology, Alappuzha Medical College, Kerala. 3Senior Resident, Department of Urology, Trivandrum Medical College, Trivandrum. 4Senior Resident, Department of Urology, Trivandrum Medical College, Trivandrum. 5Senior Resident, Department of Urology, Trivandrum Medical College, Trivandrum. ABSTRACT BACKGROUND Ureteric strictures are common diseases of India due to tuberculosis, instrumentation, congenital and other reasons. In this study we found that tuberculosis (27%) and instrumentation (27%) were the leading causes of ureteric stricture. MATERIALS AND METHODS This is a prospective study conducted in the Department of Urology, Government Medical College, Thiruvananthapuram. Cases diagnosed as ureteric strictures by IVP and CT scan were taken up for this study. Their clinical features, investigations, treatment and surgical options were studied. RESULTS The total number of cases studied were 11 (5 males and 6 females). We found that three patients had tuberculous strictures and two patients had lower ureteric strictures with obstructive megaureter like presentation. Three cases had upper ureteric strictures with unknown aetiology. Three cases had iatrogenic ureteric strictures secondary to instrumentation. CONCLUSION We concluded from our study that Tuberculosis is a common cause of ureteric stricture. Prior history of instrumentation is the second most common cause of ureteric stricture. Lower ureteric stricture with obstructive megaureter like presentation was also not uncommon and an equally significant group of ureteric strictures had unknown aetiology. KEYWORDS Ureteric Stricture, Tuberculosis, Iatrogenic Stricture, Obstructive Megaureter, Instrumentation.
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  • Surgery for Colon and Rectal Cancer
    Colon and Rectal Surgery Mohammed Bayasi, MD Department of Surgery Colon and Rectal Surgery What is a Colon and Rectal Surgeon? • Fully trained General Surgeon. • Has done additional training in the diseases of colon and rectum. Why Colon and Rectal Surgery? • Surgical and non surgical therapy for multiple diseases. • Chance to help cancer patients by removing tumor, potentially curing them. • Variety of cases, ages and patient populations. • Specialized area. Colorectal Diseases • Colon • Rectum/Anus – Cancer – Hemorrhoids – Diverticulitis – Anal fistula and – Inflammatory Bowel abscess Disease (Crohn, UC) – Anal fissure – Polyps – Prolapse Symptoms/Signs • Pain • Itching • Discharge • Bleeding • Lump Anatomy Lesson Colon • Extracts water and nutrients. • Helps to form and excrete waste. • Stores important bacteria flora. • Length: 1.5 meters long = 4.9 feet = 59 inches Colon Rectum/Anus • The final portion of the colon. • Area contains muscles important in controlling defecation and flatulence. Rectum/Anus When to see a Colon and Rectal Surgeon • Referral from another physician (Gastroenterology, PCP). • Treatment of anorectal diseases. • Blood with stool, abdominal pain, rectal pain. Hemorrhoids • Internal and external. • Cushions of blood vessels. • When enlarged, they cause bleeding and pain. Treatment • Treatment of symptomatic hemorrhoids is directed by the symptoms themselves. It can broadly be categorized into four groups: − Medical therapy − Office-based procedure − Operative therapies − Emergent interventions Anorectal Abscess • It is a collection of pus in the perianal area. Normal • Causes pain and rectal gland drainage, and if it progresses, fever and systemic Abscess infection. • Treated with incision and drainage. Anorectal Fistula • A tunnel between the inside of the anus and the skin. • Causes discharge, pain, and formation of abscess.
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  • Cervical Stenosis Causing Haematocervix and Haematometra in a Postmenopausal Woman Nicola English, Ellen Harker, Mathias Epee-Bekima
    Images in… BMJ Case Reports: first published as 10.1136/bcr-2016-217161 on 23 August 2016. Downloaded from Cervical stenosis causing haematocervix and haematometra in a postmenopausal woman Nicola English, Ellen Harker, Mathias Epee-Bekima King Edward Memorial DESCRIPTION Prior to the procedure she presented with wor- Hospital for Women Perth, A 73-year-old woman was referred to our gynaecol- sening suprapubic pain. She was febrile and tender Subiaco, Western Australia, Australia ogy clinic with a 2-week history of pelvic and suprapubically. An emergency EUA was performed vaginal pain. The pelvic ultrasound and CT scan with a presumptive diagnosis of an infected Correspondence to suggested a 10 cm haematometra and a 4 cm haematometra. Dr Nicola English, nicola. cervical cyst (figures 1–4). At time of surgery the initial cervical mass was [email protected] She had no history of postmenopausal bleeding found to be a large haematocervix with stenosis of Accepted 6 August 2016 and her most recent pap smear was normal. the external os. The cervix was incised and dilated The patient had been using tamoxifen for the which drained 800 mL of old blood from the previous 10 years for primary breast cancer. cervix and uterus. The underlying endometrium Examination revealed a large, mobile uterus and appeared normal on hysteroscopy. Histology was what appeared to be a cervical mass obscuring the also normal. cervical os. She was discharged home well on day 4 She was booked for an examination under anaes- postoperatively. thesia and hysteroscopy. http://casereports.bmj.com/ Figure 1 Pelvic ultrasound scan featuring a large haematometra.
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  • Common Anorectal Conditions
    TurkJMedSci 34(2004)285-293 ©TÜB‹TAK PERSPECTIVESINMEDICALSCIENCES CommonAnorectalConditions PravinJ.GUPTA ConsultingProctologistGuptaNursingHome,D/9,Laxminagar,NAGPUR-440022INDIA Received:July12,2004 Anorectaldisordersincludeadiversegroupof dentateorpectinatelinedividesthesquamousepithelium pathologicdisordersthatgeneratesignificantpatient fromthemucosalorcolumnarepithelium.Fourtoeight discomfortanddisability.Althoughthesearefrequently analglandsdrainintothecryptsofMorgagniatthelevel encounteredingeneralmedicalpractice,theyoften ofthedentateline.Mostrectalabscessesandfistulae receiveonlycasualattentionandtemporaryrelief . originateintheseglands.Thedentatelinealsodelineates Diseasesoftherectumandanusarecommon theareawheresensoryfibersend.Abovethedentate phenomena.Theirprevalenceinthegeneralpopulationis line,therectumissuppliedbystretchnervefibers,and probablymuchhigherthanthatseeninclinicalpractice, notpainnervefibers.Thisallowsmanysurgical sincemostpatientswithsymptomsreferabletothe procedurestobeperformedwithoutanesthesiaabovethe anorectumdonotseekmedicalattention. dentateline.Conversely,belowthedentateline,thereis extremesensitivity,andtheperianalareaisoneofthe Asdoctorsoffirstcontact,general(family) mostsensitiveareasofthebody.Theevacuationofbowel practitioners(GPs)frequentlyfacedifficultquestions contentsdependsonactionbythemusclesofboththe concerningtheoptimummanagementofanorectal involuntaryinternalsphincterandthevoluntaryexternal symptoms.Whiletheexaminationanddiagnosisof sphincter. certainanorectaldisorderscanbechallenging,itisa
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  • Ureter an Innocent Bystander: Lower Ureteral Stricture Following
    Arch Nephrol Urol 2019; 2 (2): 029-032 DOI: 10.26502/anu.2644-2833007 Case Report Ureter an Innocent Bystander: Lower Ureteral Stricture Following Angioembolisation of Uterine Artery Tushar Aditya Narain1, Manjeet Kumar2*, Shrawan Singh1, Gopal Sharma1, Shantanu Tyagi1 1Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India 2Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh, India *Corresponding Author: Dr. Manjeet Kumar, Department of Urology, Indira Gandhi Medical College and Hospital (IGMC), Shimla, Himachal Pradesh, India, E-mail: [email protected] Received: 24 May 2019; Accepted: 31 May 2019; Published: 10 June 2019 Abstract Lower ureteric strictures are a common cause for unilateral hydroureteronephrosis, commonly resulting from previous surgeries, weather endoscopic, laproscopic or open. Devascularisation of the ureter resulting in fibrosis forms the underlying pathophysiology of stricture formation. We report a case of ureteral stricture resulting from angioembolization done for a bleeding arteriovenous malformation (AVM) of the uterus. Keywords: Angioembolisation; Stricture; Ureter 1. Introduction The main cause for ureteral stricture are surgical trauma, impacted ureteral stones, extrinsic compression from a tumor and congenital narrowing. Ureteral stricture is the most frequent complication observed in pelvic surgery. Ureteral strictures are typically due to ischemia, resulting in fibrosis. Wolf and colleagues defined a stricture as ischemic, when it follows open surgery or radiation therapy, whereas a stricture is considered nonischemic if it is caused by spontaneous stone passage or a congenital abnormality [1]. We report a case of ureteral stricture which developed after angioembolisation of bilateral uterine artery done for a bleeding arterio-venous malformation of the uterine cavity.
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  • Word You Cannot Say on Tv
    THE “V” WORD YOU CANNOT SAY ON TV SHELAGH LARSON, DNP, APRN WHNP, NCMP © Copyright 2020 Shelagh Larson Title Lorem Ipsum Dolor Lorem ipsum dolor sit amet Lorem ipsum dolor sit amet 2017 2018 2019 Lorem ipsum dolor sit amet CELEBRITIES CAUGHT IN AWKWARD POSITIONS PARTS Vulva vagina is a specific internal structure, whereas the vulva is the whole external genitalia Gateway to the vagina is the seat for female sexual pleasure helps by flushing out the vulvovaginal fluids and usually maintains normal vaginal health Vestibule Secretions of fluid from the vestibule glands lubricate the vaginal orifice during sexual excitement. is the space between the labia minora and vagina Vagina The inside parts The hallway to the Uterus ◦ Vagina Dentata. Vagina Myths ◦ •Period Is Punishment ◦ •Hysteria ◦ •You Can’t Get Pregnant If It’s Legitimate Rape ◦ Sex With A Virgin Can Cure HIV/AIDS ◦ You can see someone's vagina if they go commando ◦ Douching after sex prevents pregnancy ◦ You can't get STDs from oral sex. ◦ You can lose something if inserted into the vagina ◦ You can't get pregnant if you have sex on your period The Vagina ◦ women of reproductive age, Lactobacillusis the predominant constituent of normal vaginal flora. ◦ Colonization by these bacteria keeps vaginal pH in the normal range (3.8 to 4.2), ◦ High estrogen levels maintain vaginal thickness, bolstering local defenses. ◦ Postmenopause a marked decrease in estrogen causes vaginal thinning, increasing vulnerability to infection and inflammation. ◦ Some treatments (eg, oophorectomy, birth
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  • Onlay Repair Technique for the Management of Ureteral Strictures: a Comprehensive Review
    Hindawi BioMed Research International Volume 2020, Article ID 6178286, 11 pages https://doi.org/10.1155/2020/6178286 Review Article Onlay Repair Technique for the Management of Ureteral Strictures: A Comprehensive Review Shengwei Xiong ,1,2,3 Jie Wang,1,2,3 Weijie Zhu,1,2,3 Kunlin Yang,1,2,3 Guangpu Ding,1,2,3 Xuesong Li ,1,2,3 and Daniel D. Eun 4 1Department of Urology, Peking University First Hospital, No. 8 Xishiku St, Xicheng District, Beijing 100034, China 2Institute of Urology, Peking University, No. 8 Xishiku St, Xicheng District, Beijing 100034, China 3National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing 100034, China 4Department of Urology, Temple University School of Medicine, 255S 17th Street, 7th Floor Medical Tower, Philadelphia, PA 19103, USA Correspondence should be addressed to Xuesong Li; [email protected] and Daniel D. Eun; [email protected] Received 5 March 2020; Revised 29 June 2020; Accepted 6 July 2020; Published 28 July 2020 Academic Editor: Achim Langenbucher Copyright © 2020 Shengwei Xiong et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ureteroplasty using onlay grafts or flaps emerged as an innovative procedure for the management of proximal and midureteral strictures. Autologous grafts or flaps used commonly in ureteroplasty include the oral mucosae, bladder mucosae, ileal mucosae, and appendiceal mucosae. Oral mucosa grafts, especially buccal mucosa grafts (BMGs), have gained wide acceptance as a graft choice for ureteroplasty.
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  • Crohn's Disease of the Anal Region
    Gut: first published as 10.1136/gut.6.6.515 on 1 December 1965. Downloaded from Gut, 1965, 6, 515 Crohn's disease of the anal region B. K. GRAY, H. E. LOCKHART-MUMMERY, AND B. C. MORSON From the Research Department, St. Mark's Hospital, London EDITORIAL SYNOPSIS This paper records for the first time the clinico-pathological picture of Crohn's disease affecting the anal canal. It has long been recognized that anal lesions may precede intestinal Crohn's disease, often by some years, but the specific characteristics of the lesion have not hitherto been described. The differential diagnosis is discussed in detail. In a previous report from this hospital (Morson and types of anal lesion when the patients were first seen Lockhart-Mummery, 1959) the clinical features and were as follows: pathology of the anal lesions of Crohn's disease were described. In that paper reference was made to Anal fistula, single or multiple .............. 13 several patients with anal fissures or fistulae, biopsy Anal fissures ........... ......... 3 of which showed a sarcoid reaction, but in whom Anal fissure and fistula .................... 3 there was no clinical or radiological evidence of Total 19 intra-abdominal Crohn's disease. The opinion was expressed that some of these patients might later The types of fistula included both low level and prove to have intestinal pathology. This present complex high level varieties. The majority had the contribution is a follow-up of these cases as well as clinical features described previously (Morson and of others seen subsequently. Lockhart-Mummery, 1959; Lockhart-Mummery Involvement of the anus in Crohn's disease has and Morson, 1964) which suggest Crohn's disease, http://gut.bmj.com/ been seen at this hospital in three different ways: that is, the lesions had an indolent appearance with 1 Patients who presented with symptoms of irregular undermined edges and absence of indura- intestinal Crohn's disease who, at the same time, ation.
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  • Female Genital Tract Done By
    Systemicist Pathology.. Lecture # 9& 10 Title : Female Genital Tract Done by: Dema Mhmd Khdier A man may die, nations may rise and fall…….But an idea lives on Vulva afeect all the linning of gt Some diseases can affect the vulva: 1)Vulvitis 2)Bartholin cyst :Obstruction of the excretory ducts of the gland 3)Dermatologic disorders 4) Non-specific epithelial disorders 5)Tumors Tumors & tumor like lesions Condyloma accuminatum : Hyperpigmented papules on genital skin OR Genital warts appear. caused by human papillomavirus (HPV) infection. 1) Condyloma accuminatum : 1)Usually multiple lesions 2)Associated with HPV 6 and HPV 11 Koilocytosis hollow. low grade 3) Not precancerous 4) May coexist with foci of (VIN grade I ) 2) Vulvar intraepithelial neoplasia (VIN) 1)Classic VIN Differentiated VIN _Young patients (40-60 y) _HPV associated _Usually multiple **low grade VIN (VINI) _HPV 6, 11 _NOT precancerous lesion _May coexist with conduloma accuminatum **High grade VIN: VIN II and VIN III (CIS) _HPV 16, 18 _May coexist with vaginal or cervical carcinoma. 2)Differentiated VIN _Older women > 60 y _NOT HPV associated _P53 mutation 3)Carcinoma of the vulva _3% of all genital tract cancers in women _Squamous cell carcinoma 95% _ Adenocarcinoma : 1-Bartholin gland CA 2 -Eccrine gland CA _ Extramammary paget disease _Melanoma _ Basal cell carcinoma (extremely rare Gross Appearance leukoplakia :white patch on a mucous membrane & associated with risk of cancer. Exophytic: describe solid organ lesions arising from the outer surface of the organ Most common on labia majora endophytic: grow inward into tissues in fingerlike projections from a superficial site of origin.
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  • Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-In-Ano, and Rectovaginal Fistula Jon D
    PRACTICE GUIDELINES Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula Jon D. Vogel, M.D. • Eric K. Johnson, M.D. • Arden M. Morris, M.D. • Ian M. Paquette, M.D. Theodore J. Saclarides, M.D. • Daniel L. Feingold, M.D. • Scott R. Steele, M.D. Prepared on behalf of The Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Sur- and submucosal locations.7–11 Anorectal abscess occurs geons is dedicated to ensuring high-quality pa- more often in males than females, and may occur at any Ttient care by advancing the science, prevention, age, with peak incidence among 20 to 40 year olds.4,8–12 and management of disorders and diseases of the co- In general, the abscess is treated with prompt incision lon, rectum, and anus. The Clinical Practice Guide- and drainage.4,6,10,13 lines Committee is charged with leading international Fistula-in-ano is a tract that connects the perine- efforts in defining quality care for conditions related al skin to the anal canal. In patients with an anorec- to the colon, rectum, and anus by developing clinical tal abscess, 30% to 70% present with a concomitant practice guidelines based on the best available evidence. fistula-in-ano, and, in those who do not, one-third will These guidelines are inclusive, not prescriptive, and are be diagnosed with a fistula in the months to years after intended for the use of all practitioners, health care abscess drainage.2,5,8–10,13–16 Although a perianal abscess workers, and patients who desire information about the is defined by the anatomic space in which it forms, a management of the conditions addressed by the topics fistula-in-ano is classified in terms of its relationship to covered in these guidelines.
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