11/222. Leukocyte adhesion deficiency. Leukocyte adhesion deficiency is a rare syndrome with autosomal recessive pattern of inheritance. An eleven-month-old boy, whose parents were first degree relatives, was referred to clinic with recurrent episodes of pneumonia, otitis and extensive necrotic wounds of perianal area since neonatal period. His umbilical cord had separated 30 days after birth. Laboratory findings included marked leukocytosis, chemotaxis abnormality, and very low levels of CD 11 (0.5%) and CD 18 (2%). Leukocyte Adhesion Defect (LAD) is rare genetic defect of a group of leukocyte membrane glycoproteins. LAD affects nearly one out of every million individuals and is characterized by recurrent bacterial and fungal infections of skin and mucous membranes, diminished pus formation, delayed umbilical cord separation, granulocytosis, poor wound healing and progressive periodontitis. This is the first report of a case of LAD in Isfahan of iran. ( info) |
12/222. A calculus within an anal fistula tract in a diabetic patient. A non-insulin dependent diabetic patient with a chronic anal fistula underwent fistulectomy. At operation a calculus was discovered. The patient had an uneventful recovery and healing of the wound in 4 weeks duration. The only case reported previously was in a nondiabetic patient and interestingly from this department. ( info) |
13/222. methadone in treatment of tenesmus not responding to morphine escalation. Tenesmus is a painful sensation of incomplete evacuation of the bowel and is often associated with poorly localized perineal pain. We describe a 68-year-old man with locally advanced rectal carcinoma metastatic to lung and with unbearable rectal-perineal pain unresponsive to morphine and ketorolac. Treatment with oral methadone was successful and pain improved considerably. methadone has been reported to improve pain relief in patients with morphine resistance, and it is lipophilic and exerts a lesser activity on opioid receptors in the gastrointestinal tract. ( info) |
14/222. Perianal pseudoverrucose papules and nodules mimicking condylomata acuminata and child sexual abuse. We describe an 8-year-old male with perianal nodules and papules mistaken for condylomata acuminata by the referring physician, raising the question of sexual abuse. Examination and histology at the Department of dermatology supported the diagnosis of perianal pseudoverrucose papules and nodules (PPPN). ( info) |
15/222. Difficult wart cases -- use of imiquimod cream 5%. Treatment of genital warts is a significant part of genitourinary medicine work load. Home therapies are the sensible way forward. Even problem cases can be managed successfully. Four difficult cases with successful outcomes are discussed. ( info) |
16/222. Characteristic intracytoplasmic material in a perianal wart that contains human papillomavirus type 56 and 16 dna. We report the case of a perianal wart in which human papillomavirus type 56 and 16 DNAs were detected, arising in a 29-year-old healthy Japanese female. Clinically, moist erythema and small flat pinkish papules appeared around the anus and worsened over a period of 6 months. Histopathologically, no signs of dysplasia or atypia were apparent. An area of intracytoplasmic material, which was homogeneous and eosinophilic, was contained in each epidermal cell. The wart showed HPV-56 and HPV-16 DNAs by PCR and reverse-phase dot blot hybridization. Additional Southern blot analysis showed the amount of HPV-56 dna to be more than 10 times that of HPV-16 dna. This is the first case, to our knowledge, of a perianal wart with intracytoplasmic material, which contains HPV DNAs causing mucous lesions. ( info) |
17/222. Giant condyloma acuminatum of the anorectum: trends in epidemiology and management: report of a case and review of the literature. PURPOSE: Giant condyloma acuminatum (Buschke-Loewenstein tumor) of the anorectum is a rare disease with a potentially fatal course. Controversy exists as to the epidemiology, pathologic nature, and management of the tumor. methods: We present a 42-year-old male with a 12-cm x 10-cm exophytic mass of the anal verge. Treatment included wide local excision and partial closure with rotation flaps. pathology revealed a giant condyloma acuminatum with foci of well-differentiated squamous-cell carcinoma. We identified 51 reported cases of giant condyloma acuminatum in the English literature, and to our knowledge this is the largest review to date. RESULTS: Giant condyloma acuminatum presents with a 2.7:1 male-to-female ratio. For patients younger than 50 years of age, this ratio is increased to 3.5:1. The mean age at presentation is 43.9 years, 42.9 in males and 46.6 in females (P = 0.44). There seems to be a recent trend toward a younger presentation. The most common presenting symptoms are perianal mass (47 percent), pain (32 percent), abscess or fistula (32 percent), and bleeding (18 percent). Giant condyloma acuminatum has been linked to human papilloma virus and has distinct histologic features. Foci of invasive carcinoma are noted in 50 percent of the reports, "carcinoma in situ" in 8 percent, and no invasion in 42 percent. Historically, treatment strategies have included topical chemotherapy, wide local excision, abdominopelvic resection, and the frequent addition of adjuvant and neoadjuvant systemic chemotherapy and radiation therapy. recurrence is common. CONCLUSION: There seems to be a trend toward younger age at presentation and male predominance of giant condyloma acuminatum of the anorectum. Foci of invasive cancer within giant condyloma specimens are of uncertain significance and do not seem to correlate with recurrence or prognosis. Local invasion and local recurrence are the major source of morbidity in this disease. Complete excision is the preferred initial therapy when feasible. Wide local excision, fecal diversion, or abdominoperineal resection have been used. Chemotherapy with 5-fluorouracil and focused radiation therapy may be used in certain cases of recurrence or extensive pelvic disease, with unpredictable response. Controlled, prospective, multi-institutional studies are necessary to further define the nature and treatment of this rare disease. ( info) |
18/222. Low-dose intravenous lidocaine as treatment for proctalgia fugax. BACKGROUND: Proctalgia fugax is characterized by a sudden internal anal sphincter and anorectic ring attack of pain of a short duration. OBJECTIVE: Description of the influence of intravenous lidocaine treatment for proctalgia fugax. CASE REPORT: A 28-year-old patient suffering of proctalgia fugax for 8 months. Conventional treatment efforts did not improve his condition. A single dose of an intravenous lidocaine infusion completely stopped his pain attacks. CONCLUSIONS: Based on the experience reported in this case and the potential benefit of this treatment for proctalgia fugax, controlled studies comparing intravenous lidocaine with placebo should be conducted to confirm the observation and to provide a more concrete basis for the use of intravenous lidocaine for this indication. ( info) |
| We report a patient with an unusual anal ulceration. The biopsy of an anal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, observed in the lungs, small and large bowel. The anorectal disease frequently represents a secondary site of disease, and the patient must be better evaluated. ( info) |
20/222. Perianal ulcerations from topical steroid use. Topical steroids play an extremely important role in the treatment of various dermatologic conditions. Use of topical steroids must be approached with caution, however, as they can have serious side effects. We report a case of iatrogenic perianal ulcers caused by twice-daily application of Lotrisone (clotrimazole and betamethasone dipropionate) in the perianal region. High-potency topical steroids should be used sparingly and briefly in intertriginous areas. ( info) |