Anorectal melanoma is a rare tumor representing less than 1% of anorectal cancers and around 0.3% of malignant melanomas. Its prognosis is particularly poor due to the early occurrence of metastases. We report the cas...Anorectal melanoma is a rare tumor representing less than 1% of anorectal cancers and around 0.3% of malignant melanomas. Its prognosis is particularly poor due to the early occurrence of metastases. We report the case of a 65-year-old man presenting with rectorrhagia and anal pain, initially diagnosed as hemorrhoidal disease. Subsequent proctological examination revealed an ulcerating-bourging tumor, confirmed histologically as an anorectal melanoma. After a normal extension workup, an abdominoperineal amputation was performed. Anorectal melanoma is a pathology with a poor prognosis, requiring early diagnosis to improve chances of survival.展开更多
In this manuscript,I comment on the article by Pospisilova et al published in the recent issue of the journal,in which selective embolization was used to treat anorectal hemangioma,a rare disease causing lower gastroi...In this manuscript,I comment on the article by Pospisilova et al published in the recent issue of the journal,in which selective embolization was used to treat anorectal hemangioma,a rare disease causing lower gastrointestinal bleeding.Anorectal hemangioma can easily be mistaken;for example,the patient in this case was previously misdiagnosed with ulcerative colitis.Choosing the appropriate tests and understanding the typical manifestations of anorectal hemangioma under colonoscopy,computerized tomography,magnetic resonance imaging and other tests are beneficial for diagnosis.The patient presented with intermittent rectal bleeding despite treatment with azathioprine and mesalazine and required blood transfusions since the degree of rectal bleeding worsened.Selective embolization successfully alleviated the patient’s bleeding symptoms and avoided the need for repeated blood transfusions.Tranexamic acid may be useful,considering that the patient still has bleeding symptoms and requires parenteral iron supplementation.展开更多
In this editorial,a commentary on the article by Chang et al has been provided,the course of treatment of anorectal fistulas,especially complex and recurring ones,require accurate diagnostic procedures for determining...In this editorial,a commentary on the article by Chang et al has been provided,the course of treatment of anorectal fistulas,especially complex and recurring ones,require accurate diagnostic procedures for determining ideal surgical procedures.Conventional ways of imaging sometimes fall short,offering insufficient insights in aggravated instances.In this editorial,a novel application of hydrogen peroxide-enhanced magnetic resonance imaging(HP-MRI)that promises significant improvements in the imaging of anorectal fistula.Study is based on a retrospective investigation of 60 patients,contrasts the new HP-MRI with conventional diagnostic techniques such as physical examination,trans-perineal ultrasonography and poor spatial resolution MRI.The findings demonstrate HP-MRI's incredible diagnostic performance,with sensitivity and specificity rates of 96.08%and 90.91%,respectively,and unparalleled interobserver agreement(Kappa values ranging from 0.80 to 0.89).It has been a significant advancement for assessment of anorectal fistulas providing a better roadmap for surgical planning,lowering recurrence rates as well as reduced personal and financial burden on patients by reducing the need for repeated treatment and extended hospital stays.The remaining funds can be utilized for treatment of other medical need.Ultimately HP-MRI provides us a healthier&more efficient society by improvising patients well-being&optimized healthcare infrastructure.展开更多
OBJECTIVE:To investigate the mechanism by which An's anorectal fumigation lotion(AAFL)treats inflammatory mixed hemorrhoids.METHODS:Eighty Sprague-Dawley rats,with an equal number of males and females,were randoml...OBJECTIVE:To investigate the mechanism by which An's anorectal fumigation lotion(AAFL)treats inflammatory mixed hemorrhoids.METHODS:Eighty Sprague-Dawley rats,with an equal number of males and females,were randomly assigned to the following four groups:control,model,AAFL,and positive groups.Following hemorrhoid induction,hemorrhoidal tissues were collected from the rats for analysis.Pathological alterations in these tissues were examined via hematoxylin-eosin staining.Immunohistochemistry was used to detect inflammatory markers.The ultrastructural pathological changes in these tissues were observed by transmission electron microscopy.Reverse transcription-polymerase chain reaction and Western blotting were used to analyze the gene and protein expression of nuclear factor kappa-B(NF-κB)p65,inhibitor of kappa-B(IκB),inhibitor of NF-κB kinase(IκK-β),interleukin-1 beta(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α).RESULTS:Compared with the control group,the rats in each treatment group showed general improvements in hemorrhoidal tissue pathology.The AAFL group showed increased IκB expression and decreased IL-1β,IL-6,TNF-α,NF-κB,p65,and IκK-βexpressions.CONCLUSION:AAFL can decrease the production of inflammatory markers by targeting the NF-κB pathway,resulting in improved pathological conditions in mixed hemorrhoids.Our findings will aid in the treatment of mixed hemorrhoids.展开更多
Objective To explore the clinical effects of heat-sensitizing moxibustion on functional anorectal pain. Methods Thirty six patients with functional anorectal pain were treated with moxibustion on heat-sensitive acupun...Objective To explore the clinical effects of heat-sensitizing moxibustion on functional anorectal pain. Methods Thirty six patients with functional anorectal pain were treated with moxibustion on heat-sensitive acupuncture points.The heat-sensitized points include Chángqiáng（长强 GV l）, Cìliáo（次髎 BL 32）, Yāoshū（腰俞 GV 2）, and local perianal points. A course of treatment consisted of treatment at each heat-sensitized point for 15 min once per day for 10 days. The therapeutic effects were observed after continuous treatment for 3 treatment cycles. Results Twelve cases were cured, eleven cases had effective results, and 3 cases were ineffective. The total effectiveness rate was 91.7%. The visual analog scale（VAS） total score was 6.1±1.52 before treatment and was 1.63±1.05 after treatment, showing a statistically significant difference（P〈0.01）. Conclusion Heat-sensitization moxibustion can significantly relieve functional anorectal pain.展开更多
Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders.Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting,but pati...Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders.Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting,but patients tend not to seek medical attention due to embarrassment or fear of cancer.As a result,patients frequently present with advanced disease after experiencing significant decreases in quality of life.A number of patients with anorectal complaints are referred to gastroenterologists.However,gastroenterologists' knowledge and experience in approaching these conditions may not be sufficient.This article can serve as a guide to gastroenterologists to recognize,evaluate,and manage medically or non-surgically common benign anorectal disorders,and to identify when surgical referrals are most prudent.A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic.Topics reviewed include hemorrhoids,anal fissures,anorectal fistulas and abscesses,and pruritus ani.展开更多
AIM： TO evaluate the status of anorectal function after repeated transanal endoscopic microsurgery （TEN）. METHODS： Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included. There...AIM： TO evaluate the status of anorectal function after repeated transanal endoscopic microsurgery （TEN）. METHODS： Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included. There were more than 5 large （〉 1 cm） polyps in the remaining rectum （range： 6-20 cm from the anal edge）. All patients, 19 with villous adenomas and 2 with low-grade adenocarcinomas, underwent TEM with submucosal endoscopic excision at least twice between 2005 and 2011. Anorectal manometry and a question- naire about incontinence were carried out at week 1 before operation, and at weeks 2 and 3 and 6 mo after the last operation. Anal resting pressure, maxi- mum squeeze pressure, maximum tolerable volume （MTV） and rectoanal inhibitory reflexes （RAIR） were recorded. The integrity and thickness of the internal anal sphincter （IAS） and external anal sphincter （EAS） were also evaluated by endoanal ultrasonography. We determined the physical and mental health status with SF-36 score to assess the effect of multiple TEM on patient quality of life （QoL）. RESULTS： All patients answered the questionnaire. Apart from negative RAIR in 4 patients, all of the anorectal manometric values in the 21 patients were normal before operation. Mean anal resting pressure decreased from 38±5 mmHg to 19±3 mmHg （38±5 mmHg vs 19±3 mmHg, P = 0.000） and MTV from 165± 19mLto60± 11mL（165± 19mLvs60± 11 mL, P = 0.000） at month 3 after surgery. Anal resting pressure and MTV were 37 ± 5 mmHg （38 ± 5 mmHg vs 37 ± 5 mmHg, P = 0.057） and 159 ± 19 mL （165 ± 19 mL vs 159 ± 19 mL, P = 0.071）, respectively, at month 6 after TEM. Maximal squeeze pressure de- creased from 171 ± 19 mmHg to 62 ± 12 mmHg （171 ± 19 mmHg vs 62 ± 12 mmHg, P = 0.000） at week 2 after operation, and returned to normal values by postoperative month 3 （171 ± 19 vs 166 ± 18, P = 0.051）. RAIR were absent in 4 patients preoperatively and in 12 （χ2 = 4.947, P = 0.026） patients at month 3 after surgery. PAIR was absent only in 5 patients at postoperative month 6 （χ2 = 0.141, P = 0.707）. Endo- sonography demonstrated that IAS disruption occurred in 8 patients, and 6 patients had temporary inconti- nence to flatus that was normalized by postoperative month 3. IAS thickness decreased from 1.9 ± 0.6 mm preoperatively to 1.3 ± 0.4 mm （1.9 ± 0.6 mm vs 1.3 ± 0.4 mm, P = 0.000） at postoperative month 3 and increased to 1.8 ± 0.5 mm （1.9 ± 0.6 mm vs 1.8 ± 0.5 mm, P = 0.239） at postoperative month 6. EAS thickness decreased from 3.7 ± 0.6 mm preoperatively to 3.5 ± 0.3 mm （3.7 ± 0.6 mm vs 3.5 ± 0.3 mm, P = 0.510） at month 3 and then increased to 3.6 ± 0.4 mm （3.7 ± 0.6 mm vs 3.6 ± 0.4 mm, P = 0.123） at month 6 after operation. Most patients had frequent stools per day and relatively high Wexner scores in a short time period. While actual fecal incontinence was exceptional, episodes of soiling were reported by 3 pa- tients. With regard to the QoL, the physical and mental health status scores （SF-36） were 56.1 and 46.2 （50 in the general population）, respectively.CONCLUSION： The anorectal function after repeated TEM is preserved. Multiple TEM procedures are useful for resection of multi-polyps in the remaining rectum.展开更多
AIM: To investigate coping mechanisms, constipation symptoms and anorectal physiology in 80 constipated subjects and 18 controls.METHODS: Constipation was diagnosed by Rome Ⅱ criteria.Coping ability and anxiety/depre...AIM: To investigate coping mechanisms, constipation symptoms and anorectal physiology in 80 constipated subjects and 18 controls.METHODS: Constipation was diagnosed by Rome Ⅱ criteria.Coping ability and anxiety/depression were assessed by validated questionnaires. Transit time and balloon distension test were performed.RESULTS: 34.5% patients were classified as slow transit type of constipation. The total colonic transit time (56 h vs 10 h, P＜0.0001) and rectal sensation including urge sensation (79 mL vs 63 mL, P = 0.019) and maximum tolerable volume (110 mL vs95 mL, P = 0.03) differed in patients and controls. Constipated subjects had significantly higher anxiety and depression scores and lower SF-36 scores in all categories. They also demonstrated higher scores of'monitoring' coping strategy (14+6 vs9+3, P = 0.001),which correlated with the rectal distension sensation (P = 0.005), urge sensation (P=0.002), and maximum tolerable volume (P = 0.035). The less use of blunting strategy predicted slow transit constipation in both univariate (P = 0.01) and multivariate analysis (P = 0.03).CONCLUSION: Defective or ineffective use of coping strategies may be an important etiology in functional constipation and subsequently reflected in abnormal anorectal physiology.展开更多
A 67-year-old woman underwent an orthotopic liver transplantation for end stage liver disease secondary to chronic autoimmune hepatitis. She developed sudden massive hematochezia on post-operative day 23 with hemodyna...A 67-year-old woman underwent an orthotopic liver transplantation for end stage liver disease secondary to chronic autoimmune hepatitis. She developed sudden massive hematochezia on post-operative day 23 with hemodynamic compromise. The source of hemorrhage was found at colonoscopy after careful irrigation and inspection to be a dieulafoy lesion situated just proximal to the anorectal junction. Hemostasis was achieved with epinephrine injection and thermal coagulation.展开更多
BACKGROUND Anorectal malignant melanoma(AMM)is a rare disorder with an extremely poor prognosis.Although there is currently no consensus on the treatment methods for AMM,surgical procedures have been the most common t...BACKGROUND Anorectal malignant melanoma(AMM)is a rare disorder with an extremely poor prognosis.Although there is currently no consensus on the treatment methods for AMM,surgical procedures have been the most common treatment methods used until now.We recently encountered a case of AMM that we diagnosed using endoscopic submucosal dissection(ESD).To our knowledge,this is the first case of ESD for AMM,suggesting that ESD can potentially be a diagnostic and treatment method for AMM.CASE S UMA/MARY A 77-year-old woman visited our hospital with a chief complaint of anal bleeding and a palpable rectal mass.Colonoscopy revealed a 20-mm protruded lesion in the lower rectum.After obtaining biopsy specimens from the lesion,although a malignant rectal tumor was suspected,a definitive diagnosis was not made.Endoscopic ultrasonography revealed tumor invasion into the submucosal layer but not the muscular layer.Therefore,we performed an excisional biopsy using ESD.Immunohistochemical examination of the ESD-resected specimen revealed tumor cells positive for Human Melanin Black-45,Melan-A,and S-100.Moreover,the tumor cells lacked melanin pigment;thus,a diagnosis of amelanotic AMM was made.Although the AMM had massively invaded the submucosal layer and both lymphatic and venous invasion were present,we closely monitored the patient without any additional therapy on the basis of her request.Six months after ESD,local recurrence was detected,and the patient consented to wide local excision.CONCL USION It is suggested that ESD is a potential diagnostic and treatment method for AMM.展开更多
AIM: To present the experience and outcomes of the surgical treatment for the patients with anorectal melanoma from the Cancer Hospital, Chinese Academy of Medical Sciences. METHODS: Medical records of the diagnosis, ...AIM: To present the experience and outcomes of the surgical treatment for the patients with anorectal melanoma from the Cancer Hospital, Chinese Academy of Medical Sciences. METHODS: Medical records of the diagnosis, surgery, and follow-up of 56 patients with anorectal melanoma who underwent surgery between 1975 and 2008 were retrospectively reviewed. The factors predictive for the survival rate of these patients were identified using multivariate analysis. RESULTS: The 5-year survival rate of the 56 patients with anorectal melanoma was 20%, 36 patients underwent abdominoperineal resection (APR) and 20 patients underwent wide local excision (WLE). The rates of local recurrence of the APR and WLE groups were 16.13% (5/36) and 68.75% (13/20), (P = 0.001), and the median survival time was 22 mo and 21 mo, respectively (P = 0.481). Univariate survival analysis demonstrated that the number of tumor and the depth of invasion had significant effects on the survival (P < 0.05). Multivariate analysis showed that the number of tumor [P = 0.017, 95% confidence interval (CI) = 1.273-11.075] and the depth of invasion (P = 0.015, 95% CI = 1.249-7.591) were independent prognostic factors influencing the survival rate. CONCLUSION: Complete or R0 resection is the first choice of treatment for anorectal melanoma, prognosis is poor regardless of surgical approach, and early diagnosis is the key to improved survival rate for patients with anorectal melanoma.展开更多
Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and man...Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis(Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.展开更多
Objective:To investigate the clinical effect of electroacupuncture combined with biofeedback on functional anorectal pain.Methods:Sixty patients diagnosed functional anorectal pain were divided into three groups by ra...Objective:To investigate the clinical effect of electroacupuncture combined with biofeedback on functional anorectal pain.Methods:Sixty patients diagnosed functional anorectal pain were divided into three groups by random number table,namely electroacupuncture group,biofeedback group,and combination group,with 20 patients in each.In the electroacupuncture group,the electroacupuncture at Dong’s points Sānqí(三其穴),including Qímén(其门),Qíjiǎo(其角),and Qízhéng(其正),and Línggǔ(灵骨),Dàbái(大白),Chángmén(肠门)of both sides was given;in the Biofeedback group,the biofeedback therapy was adopted;in the combination group,the electroacupuncture and biofeedback therapy were used.All patients were treated once a day,30 min each time,10 consecutive treatments as one treatment course,and the therapeutic effect was evaluated after 3 treatment courses.The observation indexes after the intervention:Visual analogue Scale(VAS)score,SF-36 Quality of Life Scale score,Self-rating Anxiety Scale(SAS)score,Self-rating Depression Scale(SDS)score,Anorectal manometry,Clinical efficacy,and patients’adverse reactions.Results:After treatment,the pain of patients in the three groups was alleviated than that before treatment,VAS score,SAS score,SDS score,and anorectal pressure were decreased(P<0.05),and SF-36 Quality of Life Scale score was increased(P<0.05).After treatment,in the combination group,the VAS scores,SAS scores,SDS scores,and Anal-rectal pressure scores were lower than those in the other two groups(P<0.05),and SF-36 Quality of Life Scale scores were higher than those in the other two groups(P<0.05),the total effective rate was 80.0%(16/20),which was significantly higher than that of the electroacupuncture group(55.0%,11/20)and the biofeedback group(40.0%,8/20)(both P<0.05).No adverse reactions occurred in all three groups.Conclusion:Electroacupuncture at Dong’s points combined with biofeedback therapy has a significant effect on functional anorectal pain.The combined application of electroacupuncture and biofeedback therapy has a synergic action,and the analgesic effect is better than that of only using electroacupuncture or biofeedback therapy.展开更多
AIM:To analyze clinical and pathological characteristics of an aggressive subtype of perianal Paget's disease(PPD) and explore its rational treatment modalities.METHODS:PPD patients were retrospectively collected ...AIM:To analyze clinical and pathological characteristics of an aggressive subtype of perianal Paget's disease(PPD) and explore its rational treatment modalities.METHODS:PPD patients were retrospectively collected in the institutional colorectal database of the Fudan University Shanghai Cancer Center.Detailed patient histories of past medical condition,diagnosis,treatment,and pathological findings were reviewed.Surgical specimen from diagnosis and surgery were reviewed by two independent pathologists for confirmation of diagnoses.Follow up was accomplished by clinical interview by cellphone.RESULTS:In total,eight cases of PPD were analyzed.All patients had underlying anorectal adenocarcinoma,including seven with synchronous lesions and one with metachronous lesions.Moreover,all anorectal lesions had a mucin-producing component.The median age at diagnosis was 65(range 29-81 years),and the male/female ratio was 7:1.The Median follow-up time of all patients was 61.5 mo(range 10-204 mo).One patient treated with abdominoperineal resection(APR) died from lung metastases 10 mo after the APR operation.The other patients are still free of disease at the time of this analysis.CONCLUSION:PPD is a rare malignancy and is easily misdiagnosed.Underlying anorectal cancer was not unusual and was a significant prognostic factor.Rational treatment of both anorectal cancer and PPD lesion is essential for long-term survival.展开更多
AIM: To investigate a new technique of the anorectal fistula treatment with acellular extracellular matrix (AEM). METHODS: Thirty patients with anorectal fistula were treated with AEM. All fistula tracts and primary o...AIM: To investigate a new technique of the anorectal fistula treatment with acellular extracellular matrix (AEM). METHODS: Thirty patients with anorectal fistula were treated with AEM. All fistula tracts and primary openings were identified using conventional fistula probe. All tracts were curetted with curet and irrigated with hydrogen peroxide and metronidazole. The AEM was pulled into the fistula tract from secondary to primary opening. The material was secured at the level of the primary opening. The excess AEM was trimmed at skin level at the secondary opening. RESULTS: All of the 30 patients had successful closure of their fistula after a 7-14 d follow-up. The healing rate of anal fistula in treatment group was 100%. The ache time, healing time and anal deformation of treatment group were obviously superior to traditional surgical methods. CONCLUSION: Using AEM anal fistula plug in treatment that causes the anorectal fistula is safe and successful in 100% of patients. It can reduce pain, shorten disease course and protect anal function.展开更多
There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctect...There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed alter restorative proctectomy for distal rectal cancer.展开更多
Anorectal malformations (ARM) are common anomalies in neonates. Diagnostic and therapeutic delays in the management of ARM may lead to colonic perforation, and even death. Physical examination of the perineum is often...Anorectal malformations (ARM) are common anomalies in neonates. Diagnostic and therapeutic delays in the management of ARM may lead to colonic perforation, and even death. Physical examination of the perineum is often sufficient to diagnose ARM in neonates. Notwithstanding, delayed diagnosis of ARM has become increasingly familiar to surgeons, as evidenced by the number of recent publications on this topic in the literature. In this commentary, we discuss spontaneous colonic perforation due to delayed diagnosis of ARM in neonates, and highlight the importance of early diagnosis in assuring good outcomes with surgical management. At this point, a thorough examination of the perineum during the initial newborn assessment is mandatory, particularly in those patients presenting with abdominal signs or symptoms.展开更多
BACKGROUND The molecular mechanisms underlying anorectal malformations(ARM)are not fully established.Circular RNAs(circRNAs)are new born non-coding RNAs,and their role in ARM is unclear.We assumed that rno_circ_000513...BACKGROUND The molecular mechanisms underlying anorectal malformations(ARM)are not fully established.Circular RNAs(circRNAs)are new born non-coding RNAs,and their role in ARM is unclear.We assumed that rno_circ_0005139 influences apoptosis and proliferation by acting as a miR-324-3p sponge,and downregulating Wnt5a in ARM.AIM To identify the differential expression of circRNAs and mRNAs in a rat ARM model.METHODS Sixty-six pregnant Wistar rats were randomly divided into two groups:ARM group(2-imidazolidinethione-induced)and control groups.Embryos were harvested by cesarean delivery,and anorectal tissue was taken on embryonic days 16(E16),17(E17),19(E19),and 21(E21).RNA sequencing and gene microarray analysis was used to identify differentially expressed circRNAs and mRNAs in the ARM in a rat model.We selected 6 circRNAs and 3 mRNAs in the Wnt signal pathway from the result of the RNA sequencing and gene microarray analysis,and quantitative reverse transcription polymerase chain reaction was performed to evaluate their tissue expression.According to bioinformatics prediction,rno_circ_0005139 acted as a miR-324-3p sponge to regulate the expression of Wnt5a.We chose rno_circ_0005139 and Wnt5a as the final candidates.We tested the function of rno_circ_0005139 and the binding sites between rno_circ_0005139 and miR-324-3p,miR-324-3p and Wnt5a by luciferase assays.Co-transfection of rno_circ_0005139 and miR-324-3p was to verify their functional consistency.RESULTS We identified 38 upregulated and 42 downregulated circRNAs on E17(P<0.05),and 301 mRNAs were upregulated and 256 downregulated in the ARM on E17(P<0.05,fold-change>2.0).We found that rno_circ_0006880 and rno_circ_0011386 were upregulated,whereas rno_circ_0000436,rno_circ_0005139,rno_circ_0009285,rno_circ_0014367,Wnt5a,Wnt10b,and Wnt2b were downregulated in ARM tissues.According to bioinformatics prediction,rno_circ_0005139 acted as a miR-324-3p sponge to regulate the expression of Wnt5a.We chose rno_circ_0005139 and Wnt5a as the final candidates.Because the role and molecular mechanism of rno_circ_0005139 are poorly understood,its effect on apoptosis and proliferation was investigated by in vitro plasmid transfection.A luciferase experiment showed that rno_circ_0005139 could bind with miR-324-3p,which negatively regulated Wnt5a expression.The expression of miR-324-3p was significantly higher in ARM anorectal tissues than that in control group on E17 and E19;Wnt5a expression showed the opposite trend.In addition,a miR-324-3p inhibitor attenuated the effects of rno_circ_0005139 knockdown on ARM development.CONCLUSION Rno_circ_0005139 influences cell proliferation and apoptosis by acting as a miR-324-3p sponge,thereby downregulating Wnt5a in ARM.Accordingly,rno_circ_0005139,miR-324-3p,and Wnt5a could be targeted therapeutic factors for ARM.展开更多
AIM： To evaluate the effect of sumatriptan, a selective 5-HT1 agonist, on anorectal function in irritable bowel syndrome （IBS） patients. METHODS： Twenty-two IBS patients selected according to the Rome II criteria ...AIM： To evaluate the effect of sumatriptan, a selective 5-HT1 agonist, on anorectal function in irritable bowel syndrome （IBS） patients. METHODS： Twenty-two IBS patients selected according to the Rome II criteria （F 15, M 7; mean age 29.3±6.8, range 22-44 years） were examined. The study was blind, randomized and placebo-controlled with a crossover design. Anorectal manometry and rectal balloon distension test were performed before and after the administration of placebo and sumatriptan. RESULTS： The administration of sumatriptan caused a significant increase in the resting anal canal pressure from 9.2±2.0 kPa to 13.1±3.3 kPa （P〈0.0001） connected with the increase in the anal sphincter length and high pressure zone. After sumatriptan injection a remarkable increase in the threshold for the first sensation from 27±9 mL to 34±12 mL （P〈0.05） and urge sensation from 61±19 mL to 68±18 mL （P〈0.01） was observed. Sumatriptan did not affect either the volume evoking the rectoanal inhibitory reflex or the results of the straining test. CONCLUSION： 5-HT1 receptors participate in the regulation of anorectal function. Elucidation of the role of 5-HT1 receptors in the pathophysiological mechanisms of IBS may have some therapeutic implications.展开更多
BACKGROUND The quality of life in patients who develop low anterior resection syndrome(LARS)after surgery for mid-low rectal cancer is seriously impaired.The underlying pathophysiological mechanism of LARS has not bee...BACKGROUND The quality of life in patients who develop low anterior resection syndrome(LARS)after surgery for mid-low rectal cancer is seriously impaired.The underlying pathophysiological mechanism of LARS has not been fully investigated.AIM To assess anorectal function of mid-low rectal cancer patients developing LARS perioperatively.METHODS Patients diagnosed with mid-low rectal cancer were included.The LARS score was used to evaluate defecation symptoms 3 and 6 mo after anterior resection or a stoma reversal procedure.Anorectal functions were assessed by threedimensional high resolution anorectal manometry preoperatively and 3-6 mo after surgery.RESULTS The study population consisted of 24 patients.The total LARS score was decreased at 6 mo compared with 3 mo after surgery(P<0.05),but 58.3%(14/24)lasted as major LARS at 6 mo after surgery.The length of the high-pressure zone of the anal sphincter was significantly shorter,the mean resting pressure and maximal squeeze pressure of the anus were significantly lower than those before surgery in allpatients (P < 0.05), especially in the neoadjuvant therapy group after surgery (n = 18). The focalpressure defects of the anal canal were detected in 70.8% of patients, and those patients had higherLARS scores at 3 mo postoperatively than those without focal pressure defects (P < 0.05). Spasticperistaltic contractions from the new rectum to anus were detected in 45.8% of patients, whichwere associated with a higher LARS score at 3 mo postoperatively (P < 0.05).CONCLUSIONThe LARS score decreases over time after surgery in the majority of patients with mid-low rectalcancer. Anorectal dysfunctions, especially focal pressure defects of the anal canal and spasticperistaltic contractions from the new rectum to anus postoperatively, might be the majorpathophysiological mechanisms of LARS.展开更多
文摘Anorectal melanoma is a rare tumor representing less than 1% of anorectal cancers and around 0.3% of malignant melanomas. Its prognosis is particularly poor due to the early occurrence of metastases. We report the case of a 65-year-old man presenting with rectorrhagia and anal pain, initially diagnosed as hemorrhoidal disease. Subsequent proctological examination revealed an ulcerating-bourging tumor, confirmed histologically as an anorectal melanoma. After a normal extension workup, an abdominoperineal amputation was performed. Anorectal melanoma is a pathology with a poor prognosis, requiring early diagnosis to improve chances of survival.
文摘In this manuscript,I comment on the article by Pospisilova et al published in the recent issue of the journal,in which selective embolization was used to treat anorectal hemangioma,a rare disease causing lower gastrointestinal bleeding.Anorectal hemangioma can easily be mistaken;for example,the patient in this case was previously misdiagnosed with ulcerative colitis.Choosing the appropriate tests and understanding the typical manifestations of anorectal hemangioma under colonoscopy,computerized tomography,magnetic resonance imaging and other tests are beneficial for diagnosis.The patient presented with intermittent rectal bleeding despite treatment with azathioprine and mesalazine and required blood transfusions since the degree of rectal bleeding worsened.Selective embolization successfully alleviated the patient’s bleeding symptoms and avoided the need for repeated blood transfusions.Tranexamic acid may be useful,considering that the patient still has bleeding symptoms and requires parenteral iron supplementation.
文摘In this editorial,a commentary on the article by Chang et al has been provided,the course of treatment of anorectal fistulas,especially complex and recurring ones,require accurate diagnostic procedures for determining ideal surgical procedures.Conventional ways of imaging sometimes fall short,offering insufficient insights in aggravated instances.In this editorial,a novel application of hydrogen peroxide-enhanced magnetic resonance imaging(HP-MRI)that promises significant improvements in the imaging of anorectal fistula.Study is based on a retrospective investigation of 60 patients,contrasts the new HP-MRI with conventional diagnostic techniques such as physical examination,trans-perineal ultrasonography and poor spatial resolution MRI.The findings demonstrate HP-MRI's incredible diagnostic performance,with sensitivity and specificity rates of 96.08%and 90.91%,respectively,and unparalleled interobserver agreement(Kappa values ranging from 0.80 to 0.89).It has been a significant advancement for assessment of anorectal fistulas providing a better roadmap for surgical planning,lowering recurrence rates as well as reduced personal and financial burden on patients by reducing the need for repeated treatment and extended hospital stays.The remaining funds can be utilized for treatment of other medical need.Ultimately HP-MRI provides us a healthier&more efficient society by improvising patients well-being&optimized healthcare infrastructure.
基金Supported by the Science and Technology Innovation Project of the Chinese Academy of Traditional Chinese Medicine:Mechanism of An's Anorectal Fumigation Lotion in the Treatment of Inflammatory Mixed hemorrhoids based on Nuclear Factor Kappa-B Pathway(No.CI2021A02104)。
文摘OBJECTIVE:To investigate the mechanism by which An's anorectal fumigation lotion(AAFL)treats inflammatory mixed hemorrhoids.METHODS:Eighty Sprague-Dawley rats,with an equal number of males and females,were randomly assigned to the following four groups:control,model,AAFL,and positive groups.Following hemorrhoid induction,hemorrhoidal tissues were collected from the rats for analysis.Pathological alterations in these tissues were examined via hematoxylin-eosin staining.Immunohistochemistry was used to detect inflammatory markers.The ultrastructural pathological changes in these tissues were observed by transmission electron microscopy.Reverse transcription-polymerase chain reaction and Western blotting were used to analyze the gene and protein expression of nuclear factor kappa-B(NF-κB)p65,inhibitor of kappa-B(IκB),inhibitor of NF-κB kinase(IκK-β),interleukin-1 beta(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α).RESULTS:Compared with the control group,the rats in each treatment group showed general improvements in hemorrhoidal tissue pathology.The AAFL group showed increased IκB expression and decreased IL-1β,IL-6,TNF-α,NF-κB,p65,and IκK-βexpressions.CONCLUSION:AAFL can decrease the production of inflammatory markers by targeting the NF-κB pathway,resulting in improved pathological conditions in mixed hemorrhoids.Our findings will aid in the treatment of mixed hemorrhoids.
文摘Objective To explore the clinical effects of heat-sensitizing moxibustion on functional anorectal pain. Methods Thirty six patients with functional anorectal pain were treated with moxibustion on heat-sensitive acupuncture points.The heat-sensitized points include Chángqiáng（长强 GV l）, Cìliáo（次髎 BL 32）, Yāoshū（腰俞 GV 2）, and local perianal points. A course of treatment consisted of treatment at each heat-sensitized point for 15 min once per day for 10 days. The therapeutic effects were observed after continuous treatment for 3 treatment cycles. Results Twelve cases were cured, eleven cases had effective results, and 3 cases were ineffective. The total effectiveness rate was 91.7%. The visual analog scale（VAS） total score was 6.1±1.52 before treatment and was 1.63±1.05 after treatment, showing a statistically significant difference（P〈0.01）. Conclusion Heat-sensitization moxibustion can significantly relieve functional anorectal pain.
文摘Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders.Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting,but patients tend not to seek medical attention due to embarrassment or fear of cancer.As a result,patients frequently present with advanced disease after experiencing significant decreases in quality of life.A number of patients with anorectal complaints are referred to gastroenterologists.However,gastroenterologists' knowledge and experience in approaching these conditions may not be sufficient.This article can serve as a guide to gastroenterologists to recognize,evaluate,and manage medically or non-surgically common benign anorectal disorders,and to identify when surgical referrals are most prudent.A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic.Topics reviewed include hemorrhoids,anal fissures,anorectal fistulas and abscesses,and pruritus ani.
基金Supported by The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University,Shanghai,China
文摘AIM： TO evaluate the status of anorectal function after repeated transanal endoscopic microsurgery （TEN）. METHODS： Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included. There were more than 5 large （〉 1 cm） polyps in the remaining rectum （range： 6-20 cm from the anal edge）. All patients, 19 with villous adenomas and 2 with low-grade adenocarcinomas, underwent TEM with submucosal endoscopic excision at least twice between 2005 and 2011. Anorectal manometry and a question- naire about incontinence were carried out at week 1 before operation, and at weeks 2 and 3 and 6 mo after the last operation. Anal resting pressure, maxi- mum squeeze pressure, maximum tolerable volume （MTV） and rectoanal inhibitory reflexes （RAIR） were recorded. The integrity and thickness of the internal anal sphincter （IAS） and external anal sphincter （EAS） were also evaluated by endoanal ultrasonography. We determined the physical and mental health status with SF-36 score to assess the effect of multiple TEM on patient quality of life （QoL）. RESULTS： All patients answered the questionnaire. Apart from negative RAIR in 4 patients, all of the anorectal manometric values in the 21 patients were normal before operation. Mean anal resting pressure decreased from 38±5 mmHg to 19±3 mmHg （38±5 mmHg vs 19±3 mmHg, P = 0.000） and MTV from 165± 19mLto60± 11mL（165± 19mLvs60± 11 mL, P = 0.000） at month 3 after surgery. Anal resting pressure and MTV were 37 ± 5 mmHg （38 ± 5 mmHg vs 37 ± 5 mmHg, P = 0.057） and 159 ± 19 mL （165 ± 19 mL vs 159 ± 19 mL, P = 0.071）, respectively, at month 6 after TEM. Maximal squeeze pressure de- creased from 171 ± 19 mmHg to 62 ± 12 mmHg （171 ± 19 mmHg vs 62 ± 12 mmHg, P = 0.000） at week 2 after operation, and returned to normal values by postoperative month 3 （171 ± 19 vs 166 ± 18, P = 0.051）. RAIR were absent in 4 patients preoperatively and in 12 （χ2 = 4.947, P = 0.026） patients at month 3 after surgery. PAIR was absent only in 5 patients at postoperative month 6 （χ2 = 0.141, P = 0.707）. Endo- sonography demonstrated that IAS disruption occurred in 8 patients, and 6 patients had temporary inconti- nence to flatus that was normalized by postoperative month 3. IAS thickness decreased from 1.9 ± 0.6 mm preoperatively to 1.3 ± 0.4 mm （1.9 ± 0.6 mm vs 1.3 ± 0.4 mm, P = 0.000） at postoperative month 3 and increased to 1.8 ± 0.5 mm （1.9 ± 0.6 mm vs 1.8 ± 0.5 mm, P = 0.239） at postoperative month 6. EAS thickness decreased from 3.7 ± 0.6 mm preoperatively to 3.5 ± 0.3 mm （3.7 ± 0.6 mm vs 3.5 ± 0.3 mm, P = 0.510） at month 3 and then increased to 3.6 ± 0.4 mm （3.7 ± 0.6 mm vs 3.6 ± 0.4 mm, P = 0.123） at month 6 after operation. Most patients had frequent stools per day and relatively high Wexner scores in a short time period. While actual fecal incontinence was exceptional, episodes of soiling were reported by 3 pa- tients. With regard to the QoL, the physical and mental health status scores （SF-36） were 56.1 and 46.2 （50 in the general population）, respectively.CONCLUSION： The anorectal function after repeated TEM is preserved. Multiple TEM procedures are useful for resection of multi-polyps in the remaining rectum.
文摘AIM: To investigate coping mechanisms, constipation symptoms and anorectal physiology in 80 constipated subjects and 18 controls.METHODS: Constipation was diagnosed by Rome Ⅱ criteria.Coping ability and anxiety/depression were assessed by validated questionnaires. Transit time and balloon distension test were performed.RESULTS: 34.5% patients were classified as slow transit type of constipation. The total colonic transit time (56 h vs 10 h, P＜0.0001) and rectal sensation including urge sensation (79 mL vs 63 mL, P = 0.019) and maximum tolerable volume (110 mL vs95 mL, P = 0.03) differed in patients and controls. Constipated subjects had significantly higher anxiety and depression scores and lower SF-36 scores in all categories. They also demonstrated higher scores of'monitoring' coping strategy (14+6 vs9+3, P = 0.001),which correlated with the rectal distension sensation (P = 0.005), urge sensation (P=0.002), and maximum tolerable volume (P = 0.035). The less use of blunting strategy predicted slow transit constipation in both univariate (P = 0.01) and multivariate analysis (P = 0.03).CONCLUSION: Defective or ineffective use of coping strategies may be an important etiology in functional constipation and subsequently reflected in abnormal anorectal physiology.
文摘A 67-year-old woman underwent an orthotopic liver transplantation for end stage liver disease secondary to chronic autoimmune hepatitis. She developed sudden massive hematochezia on post-operative day 23 with hemodynamic compromise. The source of hemorrhage was found at colonoscopy after careful irrigation and inspection to be a dieulafoy lesion situated just proximal to the anorectal junction. Hemostasis was achieved with epinephrine injection and thermal coagulation.
文摘BACKGROUND Anorectal malignant melanoma(AMM)is a rare disorder with an extremely poor prognosis.Although there is currently no consensus on the treatment methods for AMM,surgical procedures have been the most common treatment methods used until now.We recently encountered a case of AMM that we diagnosed using endoscopic submucosal dissection(ESD).To our knowledge,this is the first case of ESD for AMM,suggesting that ESD can potentially be a diagnostic and treatment method for AMM.CASE S UMA/MARY A 77-year-old woman visited our hospital with a chief complaint of anal bleeding and a palpable rectal mass.Colonoscopy revealed a 20-mm protruded lesion in the lower rectum.After obtaining biopsy specimens from the lesion,although a malignant rectal tumor was suspected,a definitive diagnosis was not made.Endoscopic ultrasonography revealed tumor invasion into the submucosal layer but not the muscular layer.Therefore,we performed an excisional biopsy using ESD.Immunohistochemical examination of the ESD-resected specimen revealed tumor cells positive for Human Melanin Black-45,Melan-A,and S-100.Moreover,the tumor cells lacked melanin pigment;thus,a diagnosis of amelanotic AMM was made.Although the AMM had massively invaded the submucosal layer and both lymphatic and venous invasion were present,we closely monitored the patient without any additional therapy on the basis of her request.Six months after ESD,local recurrence was detected,and the patient consented to wide local excision.CONCL USION It is suggested that ESD is a potential diagnostic and treatment method for AMM.
文摘AIM: To present the experience and outcomes of the surgical treatment for the patients with anorectal melanoma from the Cancer Hospital, Chinese Academy of Medical Sciences. METHODS: Medical records of the diagnosis, surgery, and follow-up of 56 patients with anorectal melanoma who underwent surgery between 1975 and 2008 were retrospectively reviewed. The factors predictive for the survival rate of these patients were identified using multivariate analysis. RESULTS: The 5-year survival rate of the 56 patients with anorectal melanoma was 20%, 36 patients underwent abdominoperineal resection (APR) and 20 patients underwent wide local excision (WLE). The rates of local recurrence of the APR and WLE groups were 16.13% (5/36) and 68.75% (13/20), (P = 0.001), and the median survival time was 22 mo and 21 mo, respectively (P = 0.481). Univariate survival analysis demonstrated that the number of tumor and the depth of invasion had significant effects on the survival (P < 0.05). Multivariate analysis showed that the number of tumor [P = 0.017, 95% confidence interval (CI) = 1.273-11.075] and the depth of invasion (P = 0.015, 95% CI = 1.249-7.591) were independent prognostic factors influencing the survival rate. CONCLUSION: Complete or R0 resection is the first choice of treatment for anorectal melanoma, prognosis is poor regardless of surgical approach, and early diagnosis is the key to improved survival rate for patients with anorectal melanoma.
文摘Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis(Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.
基金Supported by Innovation and Application Project,Chongqing Bureau of Science and Technology:cstc2019jscx-msxmX02292019"Xinglin Scholar"Project of Chongqing TCM Hospital affiliated to Chengdu University of Traditional Chinese Medicine:YYZX2019080Chongqing famous senior TCM expert Xu Yue inheritance studio。
文摘Objective:To investigate the clinical effect of electroacupuncture combined with biofeedback on functional anorectal pain.Methods:Sixty patients diagnosed functional anorectal pain were divided into three groups by random number table,namely electroacupuncture group,biofeedback group,and combination group,with 20 patients in each.In the electroacupuncture group,the electroacupuncture at Dong’s points Sānqí(三其穴),including Qímén(其门),Qíjiǎo(其角),and Qízhéng(其正),and Línggǔ(灵骨),Dàbái(大白),Chángmén(肠门)of both sides was given;in the Biofeedback group,the biofeedback therapy was adopted;in the combination group,the electroacupuncture and biofeedback therapy were used.All patients were treated once a day,30 min each time,10 consecutive treatments as one treatment course,and the therapeutic effect was evaluated after 3 treatment courses.The observation indexes after the intervention:Visual analogue Scale(VAS)score,SF-36 Quality of Life Scale score,Self-rating Anxiety Scale(SAS)score,Self-rating Depression Scale(SDS)score,Anorectal manometry,Clinical efficacy,and patients’adverse reactions.Results:After treatment,the pain of patients in the three groups was alleviated than that before treatment,VAS score,SAS score,SDS score,and anorectal pressure were decreased(P<0.05),and SF-36 Quality of Life Scale score was increased(P<0.05).After treatment,in the combination group,the VAS scores,SAS scores,SDS scores,and Anal-rectal pressure scores were lower than those in the other two groups(P<0.05),and SF-36 Quality of Life Scale scores were higher than those in the other two groups(P<0.05),the total effective rate was 80.0%(16/20),which was significantly higher than that of the electroacupuncture group(55.0%,11/20)and the biofeedback group(40.0%,8/20)(both P<0.05).No adverse reactions occurred in all three groups.Conclusion:Electroacupuncture at Dong’s points combined with biofeedback therapy has a significant effect on functional anorectal pain.The combined application of electroacupuncture and biofeedback therapy has a synergic action,and the analgesic effect is better than that of only using electroacupuncture or biofeedback therapy.
基金Supported by Key Project of Science and technology commission of Shanghai Municipality, Shanghai, China, No 07DZ19505
文摘AIM:To analyze clinical and pathological characteristics of an aggressive subtype of perianal Paget's disease(PPD) and explore its rational treatment modalities.METHODS:PPD patients were retrospectively collected in the institutional colorectal database of the Fudan University Shanghai Cancer Center.Detailed patient histories of past medical condition,diagnosis,treatment,and pathological findings were reviewed.Surgical specimen from diagnosis and surgery were reviewed by two independent pathologists for confirmation of diagnoses.Follow up was accomplished by clinical interview by cellphone.RESULTS:In total,eight cases of PPD were analyzed.All patients had underlying anorectal adenocarcinoma,including seven with synchronous lesions and one with metachronous lesions.Moreover,all anorectal lesions had a mucin-producing component.The median age at diagnosis was 65(range 29-81 years),and the male/female ratio was 7:1.The Median follow-up time of all patients was 61.5 mo(range 10-204 mo).One patient treated with abdominoperineal resection(APR) died from lung metastases 10 mo after the APR operation.The other patients are still free of disease at the time of this analysis.CONCLUSION:PPD is a rare malignancy and is easily misdiagnosed.Underlying anorectal cancer was not unusual and was a significant prognostic factor.Rational treatment of both anorectal cancer and PPD lesion is essential for long-term survival.
文摘AIM: To investigate a new technique of the anorectal fistula treatment with acellular extracellular matrix (AEM). METHODS: Thirty patients with anorectal fistula were treated with AEM. All fistula tracts and primary openings were identified using conventional fistula probe. All tracts were curetted with curet and irrigated with hydrogen peroxide and metronidazole. The AEM was pulled into the fistula tract from secondary to primary opening. The material was secured at the level of the primary opening. The excess AEM was trimmed at skin level at the secondary opening. RESULTS: All of the 30 patients had successful closure of their fistula after a 7-14 d follow-up. The healing rate of anal fistula in treatment group was 100%. The ache time, healing time and anal deformation of treatment group were obviously superior to traditional surgical methods. CONCLUSION: Using AEM anal fistula plug in treatment that causes the anorectal fistula is safe and successful in 100% of patients. It can reduce pain, shorten disease course and protect anal function.
文摘There are no reports regarding perforation of the colorectum induced by anorectal manometry. We report two cases of colorectal perforation that occurred during manometry in the patients undergoing restorative proctectomy for distal rectal cancer. In the first patient, computed tomography showed an extraperitoneal perforation in the pelvic cavity and a rupture of the rectal wall. A localized perforation into the retroperitoneum was managed conservatively. In the second patient, a 3 cm linear colon rupture was detected above the anastomotic site. A primary closure of the perforated colon and proximal ileostomy were conducted, but the patient died 2 wk later. We hypothesize that the perforation induced by anorectal manometry may be associated with the relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation. We suggest that measurement of the maximum tolerable volume should not be routinely performed alter restorative proctectomy for distal rectal cancer.
基金Supported by The National Natural Science Foundation of China,No.81270461/H0307Ministry of Education of China,No.201200356Third Military Medical University,No.2011XHG08
文摘Anorectal malformations (ARM) are common anomalies in neonates. Diagnostic and therapeutic delays in the management of ARM may lead to colonic perforation, and even death. Physical examination of the perineum is often sufficient to diagnose ARM in neonates. Notwithstanding, delayed diagnosis of ARM has become increasingly familiar to surgeons, as evidenced by the number of recent publications on this topic in the literature. In this commentary, we discuss spontaneous colonic perforation due to delayed diagnosis of ARM in neonates, and highlight the importance of early diagnosis in assuring good outcomes with surgical management. At this point, a thorough examination of the perineum during the initial newborn assessment is mandatory, particularly in those patients presenting with abdominal signs or symptoms.
基金Supported by the National Natural Science Foundation of China,No.81671503.Institutional animal care and use committee statement:All animal experiments conformed to the internationally accepted principles for the care and use of laboratory animals(licence No.2016PS045K)We would like to thank Luo K, biostatistician at the MOE-Shanghai Key Laboratory ofChildren‘s Environmental Health in Shanghai Jiao Tong University School ofMedicine, for reviewing the content of our manuscript to confirm appropriateness ofbiostatistical methods for study design.
文摘BACKGROUND The molecular mechanisms underlying anorectal malformations(ARM)are not fully established.Circular RNAs(circRNAs)are new born non-coding RNAs,and their role in ARM is unclear.We assumed that rno_circ_0005139 influences apoptosis and proliferation by acting as a miR-324-3p sponge,and downregulating Wnt5a in ARM.AIM To identify the differential expression of circRNAs and mRNAs in a rat ARM model.METHODS Sixty-six pregnant Wistar rats were randomly divided into two groups:ARM group(2-imidazolidinethione-induced)and control groups.Embryos were harvested by cesarean delivery,and anorectal tissue was taken on embryonic days 16(E16),17(E17),19(E19),and 21(E21).RNA sequencing and gene microarray analysis was used to identify differentially expressed circRNAs and mRNAs in the ARM in a rat model.We selected 6 circRNAs and 3 mRNAs in the Wnt signal pathway from the result of the RNA sequencing and gene microarray analysis,and quantitative reverse transcription polymerase chain reaction was performed to evaluate their tissue expression.According to bioinformatics prediction,rno_circ_0005139 acted as a miR-324-3p sponge to regulate the expression of Wnt5a.We chose rno_circ_0005139 and Wnt5a as the final candidates.We tested the function of rno_circ_0005139 and the binding sites between rno_circ_0005139 and miR-324-3p,miR-324-3p and Wnt5a by luciferase assays.Co-transfection of rno_circ_0005139 and miR-324-3p was to verify their functional consistency.RESULTS We identified 38 upregulated and 42 downregulated circRNAs on E17(P<0.05),and 301 mRNAs were upregulated and 256 downregulated in the ARM on E17(P<0.05,fold-change>2.0).We found that rno_circ_0006880 and rno_circ_0011386 were upregulated,whereas rno_circ_0000436,rno_circ_0005139,rno_circ_0009285,rno_circ_0014367,Wnt5a,Wnt10b,and Wnt2b were downregulated in ARM tissues.According to bioinformatics prediction,rno_circ_0005139 acted as a miR-324-3p sponge to regulate the expression of Wnt5a.We chose rno_circ_0005139 and Wnt5a as the final candidates.Because the role and molecular mechanism of rno_circ_0005139 are poorly understood,its effect on apoptosis and proliferation was investigated by in vitro plasmid transfection.A luciferase experiment showed that rno_circ_0005139 could bind with miR-324-3p,which negatively regulated Wnt5a expression.The expression of miR-324-3p was significantly higher in ARM anorectal tissues than that in control group on E17 and E19;Wnt5a expression showed the opposite trend.In addition,a miR-324-3p inhibitor attenuated the effects of rno_circ_0005139 knockdown on ARM development.CONCLUSION Rno_circ_0005139 influences cell proliferation and apoptosis by acting as a miR-324-3p sponge,thereby downregulating Wnt5a in ARM.Accordingly,rno_circ_0005139,miR-324-3p,and Wnt5a could be targeted therapeutic factors for ARM.
基金Supported by the grant from GlaxoSmithKline Pharmaceuticals S.A.
文摘AIM： To evaluate the effect of sumatriptan, a selective 5-HT1 agonist, on anorectal function in irritable bowel syndrome （IBS） patients. METHODS： Twenty-two IBS patients selected according to the Rome II criteria （F 15, M 7; mean age 29.3±6.8, range 22-44 years） were examined. The study was blind, randomized and placebo-controlled with a crossover design. Anorectal manometry and rectal balloon distension test were performed before and after the administration of placebo and sumatriptan. RESULTS： The administration of sumatriptan caused a significant increase in the resting anal canal pressure from 9.2±2.0 kPa to 13.1±3.3 kPa （P〈0.0001） connected with the increase in the anal sphincter length and high pressure zone. After sumatriptan injection a remarkable increase in the threshold for the first sensation from 27±9 mL to 34±12 mL （P〈0.05） and urge sensation from 61±19 mL to 68±18 mL （P〈0.01） was observed. Sumatriptan did not affect either the volume evoking the rectoanal inhibitory reflex or the results of the straining test. CONCLUSION： 5-HT1 receptors participate in the regulation of anorectal function. Elucidation of the role of 5-HT1 receptors in the pathophysiological mechanisms of IBS may have some therapeutic implications.
基金Supported by the National High-tech R&D Program (“863” Program) of China,No. 2010AA023007
文摘BACKGROUND The quality of life in patients who develop low anterior resection syndrome(LARS)after surgery for mid-low rectal cancer is seriously impaired.The underlying pathophysiological mechanism of LARS has not been fully investigated.AIM To assess anorectal function of mid-low rectal cancer patients developing LARS perioperatively.METHODS Patients diagnosed with mid-low rectal cancer were included.The LARS score was used to evaluate defecation symptoms 3 and 6 mo after anterior resection or a stoma reversal procedure.Anorectal functions were assessed by threedimensional high resolution anorectal manometry preoperatively and 3-6 mo after surgery.RESULTS The study population consisted of 24 patients.The total LARS score was decreased at 6 mo compared with 3 mo after surgery(P<0.05),but 58.3%(14/24)lasted as major LARS at 6 mo after surgery.The length of the high-pressure zone of the anal sphincter was significantly shorter,the mean resting pressure and maximal squeeze pressure of the anus were significantly lower than those before surgery in allpatients (P < 0.05), especially in the neoadjuvant therapy group after surgery (n = 18). The focalpressure defects of the anal canal were detected in 70.8% of patients, and those patients had higherLARS scores at 3 mo postoperatively than those without focal pressure defects (P < 0.05). Spasticperistaltic contractions from the new rectum to anus were detected in 45.8% of patients, whichwere associated with a higher LARS score at 3 mo postoperatively (P < 0.05).CONCLUSIONThe LARS score decreases over time after surgery in the majority of patients with mid-low rectalcancer. Anorectal dysfunctions, especially focal pressure defects of the anal canal and spasticperistaltic contractions from the new rectum to anus postoperatively, might be the majorpathophysiological mechanisms of LARS.
