UI - 20138879
AU - Sasaki K; Nozaki M; Kikutchi Y; Yamaki T; Soejima K
Reconstruction of perianal skin defect using a V-Y advancement of
bilateral gluteus maximus musculocutaneous flaps: reconstruction
considering anal cleft and anal function.
SO - Br J Plast Surg 1999 Sep;52(6):471-5
AD - Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical
In order to preserve the anal function after ano-perianal skin excision
for malignancy, we have reconstructed a deep, symmetrical natal cleft
using a V-Y advancement of bilateral gluteus maximus musculocutaneous
flaps thinned medially and sutured to the ooccyx, anococcygeal ligament
and the central tendon of the perineum. This technique was applied in
three cases of Bowen's disease and two cases of Paget's disease. In all
five cases, postoperative anal functions such as comfortable defecation
and sensation, were well preserved, the perianal skin and underwear
stayed clean, and there was no disturbance of walking or exercise.
UI - 21271574
AU - Ooi BS; Eu KW; Seow-Choen F
Primary anorectal malignant melanoma: clinical features and results of
surgical therapy in Singapore--a case series.
SO - Ann Acad Med Singapore 2001 Mar;30(2):203-5
AD - Department of Colorectal Surgery, Singapore General Hospital, 1 Hospital
Drive, Singapore 169608.
INTRODUCTION: Primary malignant melanoma arising from the anorectum is
uncommon. The natural history of anorectal malignant melanoma is that of
a very poor prognosis with early dissemination of disease. Successful
surgical treatment has been rare. The present series reviews the
clinical features and results of surgical management of patients with
anorectal malignant melanoma treated in the Department of Colorectal
Surgery, Singapore General Hospital. MATERIALS AND METHODS: Data for all
patients treated for anorectal malignant melanoma during an 11-year
period from 1989 to 1999 were reviewed. The age, sex, presenting
symptoms, duration of symptoms prior to diagnosis, size of tumour,
extent of disease, type of surgery and length of survival were analysed.
RESULTS: Four men and 2 women, ranging in age from 31 to 81 years with
histologically proven primary anorectal malignant melanoma, were
included in the study. The most common (67%) presenting symptom was
rectal bleeding. The mean tumour size was 2.5 cm (range 1 to 5 cm). All
underwent abdomino-perineal resection. Three died of disseminated
disease within 17 months while the other 3 were still alive at the time
of this study; the longest up to 6.5 years from the time of diagnosis.
CONCLUSION: The prognosis of primary anorectal malignant melanoma is
poor. However, it is worthwhile treating aggressively as long-term
survivor may be encountered in some.
UI - 21407978
AU - O'Mahony C; Law C; Gollnick HP; Marini M
New patient-applied therapy for anogenital warts is rated favourably by
SO - Int J STD AIDS 2001 Sep;12(9):565-70
AD - Department of Genito-Urinary Medicine, The Countess of Chester Hospital,
Countess of Chester Health Park, Liverpool Road, Chester CH2 1UL, UK.
Our objective was to determine patient attitudes to having genital
warts, and their perceptions of their treatment with imiquimod and other
therapies. As an adjunct to a clinical trial in which patients with
external genital warts were treated with imiquimod 5% cream until their
warts cleared or for up to 16 weeks, quantitative questionnaires
consisting of multiple choice questions and 5-point rating scales were
completed prior to, and at the end, of the study period. Pre-study and
post-study questionnaires were completed by 902 and 629 patients,
respectively. Patients expressed a definite concern about genital warts.
The majority of patients (70%) had been previously treated for genital
warts, and expressed dissatisfaction with their previous therapies. Of
patients treated with imiquimod in this study, 82% reported that their
warts decreased in size; this occurred within the first 4 weeks for 78%
of patients. Sixty-one per cent of patients perceived that their warts
completely cleared within the 16-week treatment period. Patients rated
imiquimod 5% cream as better than other genital wart therapies in terms
of overall satisfaction, time to clearance, convenience and lack of
associated pain. In conclusion, patients rated imiquimod 5% cream as an
effective treatment which clears warts in an acceptable length of time
causing minimal pain and is convenient to use.
UI - 21454660
AU - Anonymous
Some women may be at high risk for anal cancer.
SO - Treat Update 2001 Winter;12(10):10-1
UI - 21289729
AU - Katsinelos P; Christodoulou K; Pilpilidis I; Papagiannis A; Patakiouta
F; Xiarchos P; Amperiadis P; Eugenidis N
Anal leukoplakia: an unusual case of anal stenosis.
SO - Endoscopy 2001 May;33(5):469
AD - Dept. of Gastroenterology, Theagenion Institute of Cancer, Thessaloniki,
UI - 21476741
AU - Felz MW; Winburn GB; Kallab AM; Lee JR
Anal melanoma: an aggressive malignancy masquerading as hemorrhoids.
SO - South Med J 2001 Sep;94(9):880-5
AD - Department of Family Medicine, Surgery, and Medicine, (Section of
Medical Oncology), Medical College of Georgia, Augusta 30912, USA.
Anal melanoma is a devastating malignancy easily confused with benign
hemorrhoids. Physician unfamiliarity with this bleeding rectal lesion
can lead to delays in diagnosis and therapy. Four cases of anal
melanoma, all initially mistaken for hemorrhoids, have been documented
in the past 4 years at our institution. Despite surgical intervention
and chemoimmunotherapy, each patient succumbed to widely metastatic
disease. Average survival was 15.2 months. The clinical, pathologic,
surgical, and oncologic features of anal melanoma are reviewed to
enhance physician recognition of this unusual anorectal disorder.
UI - 21481741
AU - Kim JH; Sarani B; Orkin BA; Young HA; White J; Tannebaum I; Stein S;
HIV-positive patients with anal carcinoma have poorer treatment
tolerance and outcome than HIV-negative patients.
SO - Dis Colon Rectum 2001 Oct;44(10):1496-502
AD - Division of Colon and Rectal Surgery, George Washington University
Medical School, Washington, DC 20037, USA.
PURPOSE: Anal carcinoma is being found in HIV-positive patients with
increasing frequency. Most patients are treated with combined
chemotherapy and radiation. It was our impression that HIV-positive
patients do not fare as well as HIV-negative patients in terms of both
response to and tolerance of therapy. METHODS: To test this hypothesis,
we reviewed our experience with anal carcinoma and compared HIV-positive
to HIV-negative patients by age, gender, sexual orientation, stage at
diagnosis, treatment rendered, response to treatment, tolerance, and
survival. From 1985 to 1998, 98 patients with anal neoplasms were
treated. Seventy-three patients had invasive squamous-cell carcinoma
(including cloacogenic carcinoma), and this cohort was analyzed.
Thirteen patients were HIV positive and 60 were HIV negative. RESULTS:
The HIV-positive and HIV-negative groups differed significantly by age
(42 vs. 62 years, P < 0.001), male gender (92 vs. 42 percent, P <
0.001), and homosexuality (46 vs. 15 percent, P < 0.05). There were no
differences by stage at diagnosis or radiation dose received. Acute
treatment major toxicity differed significantly (HIV positive 80 percent
vs. HIV negative 30 percent; P < 0.005). Only 62 percent of HIV-positive
patients were rendered disease free after initial therapy vs. 85 percent
of HIV-negative patients (P = 0.11). Median time to cancer-related death
was 1.4 vs. 5.3 years (P < 0.05). A survival model did not show age,
gender, stage, or treatment to be independent predictors. CONCLUSION: We
found that HIV-positive patients with anal carcinoma seem to be a
different population from HIV-negative patients by age, gender, and
sexual orientation. They have a poorer tolerance for combined therapy
and a shorter time to cancer-related death. A strong trend to poorer
initial response rate was also seen. These results suggest that the
treatment of HIV-positive patients with anal carcinoma needs to be
UI - 21481742
AU - Gervaz P; Efron J; Poza AA; Chun SW; Pham TT; Woodhouse S; Wexner SD;
Loss of heterozygosity and HIV infection in patients with anal
SO - Dis Colon Rectum 2001 Oct;44(10):1503-8
AD - Department of Colorectal Surgery, Cleveland Clinic Florida, Weston,
Florida 33331, USA.
PURPOSE: This study was designed to determine whether loss of
heterozygosity and/or microsatellite instability correlate with HIV
infection and tumor recurrence after chemoradiation therapy in patients
with squamous-cell carcinoma of the anus. BACKGROUND: The molecular
mechanisms leading to the progression of HIV-related squamous-cell
carcinoma of the anus are poorly understood. In particular, genetic
alterations responsible for resistance to chemoradiation have important
clinical and functional implications. METHODS: In a case-control study,
we analyzed normal and tumor DNA samples of four patients with
squamous-cell carcinoma of the anus who were successfully treated with
chemoradiotherapy and four patients with radio-resistant squamous-cell
carcinoma of the anus who required abdominoperineal resection for local
recurrence. To determine the presence of microsatellite instability, we
used the reference panel of five pairs of microsatellite primers
recommended for colorectal cancer specimens. These include the
microsatellite markers BAT25, BAT26, D5S346 (APC), D2S123 (hMSH2), and
D17S250 (P53). In addition, we used microsatellite markers for loss of
heterozygosity analyses that were tightly linked to tumor suppressor
genes. These included D3S1611 (hMLH1), D17S513 (P53), D18S46 and 18qTA
(DCC/SMAD4), D5S107 (APC), and CA5 (hMSH2). RESULTS: There were two
HIV-positive and two HIV-negative patients in each group. Three
HIV-positive patients (one in the chemoradiotherapy group and two in the
nonchemoradiotherapy group) demonstrated loss of heterozygosity. In the
chemoradiotherapy group, one HIV-positive patient demonstrated loss of
heterozygosity at the hMLH1 locus. In the nonchemoradiotherapy group,
two HIV-positive patients exhibited a total of four instances of loss of
heterozygosity. One tumor had loss of heterozygosity at hMSH2 and
DCC/SMAD4; another tumor demonstrated loss of heterozygosity at hMSH2
and APC. Microsatellite instability-low was found in two HIV-positive
patients. No instances of loss of heterozygosity and microsatellite
instability were detected in HIV-negative patients. CONCLUSION: Loss of
heterozygosity and microsatellite instability, which reflect
inactivation of tumor-suppressor genes and genomic instability, occur
with increased frequency in HIV-associated squamous-cell carcinoma.
These data demonstrate for the first time evidence of loss of
heterozygosity at the APC and DCC/SMAD4 gene loci in anal carcinoma.
Although the findings presented here need to be expanded in a larger
study, the recurrent loss of heterozygosity at D2S123, which was
demonstrated in HIV-positive patients with radio-resistant squamous-cell
carcinoma of the anus, is notable.
UI - 98296218
AU - Blennerhassett M
Ethical debate. Truth, the first casualty. Deadly charades.
SO - BMJ 1998 Jun 20;316(7148):1890-1
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