AN OPEN LABEL, RANDOMIZED, COMPARATIVE, PARALLEL GROUP, SINGLE CENTER STUDY TO EVALUATE SAFETY AND EFFICACY OF ANO SPRAY IN A COMPARISON WITH BETADINE SOLUTION APPLICATION IN ACUTE PERINEUM WOUNDS

Perianal wound are common post-surgical treatment of perianal diseases and in disease near perianal region. In current existing treatment modalities there is no significant number of patients who get relief from perianal wound. We have conducted an open label, randomized, parallel group and single center study to observe safety and efficacy of Ano Spray. Total 30 patients were randomized on Ano spray group and betadine solution group (1:1 ratio). All the patients were advised to apply Ano spray and betadine solution twice daily for 4 weeks. All patients visited center on Day 0, Week 1, 2, 3 and 4. Patient’s quality of life on PAC-QOL & pain was assessed on VAS score on each visit. Local examination was done at each visit for discharge, itching and healing progress. In Ano spray patient’s group wound is significantly healed in lesser time in comparison with Betadine solution group. In both group VAS score for pain was significantly (p< 0.05) improved from baseline Day 0 to Week 4 and significantly improvement observed in Ano spray group. At the end of the study (Week 4), significant (P < 0.05) results were observed in Ano Spray group than Betadine solution group in itching and discharge associated with wound. Excellent overall efficacy and tolerability was observed in patients of both the groups. No adverse event or adverse drug reaction was noted in any patient of both the groups. Study result shows Ano Spray is safe and superior to Betadine Solution in perineum wound healing

THE EFFECT OF CONSTAC PLUS IN THE MANAGEMENT OF SEVERE CHRONIC CONSTIPATION: A PILOT STUDY

The purpose of this study was to evaluate the efficacy of CONSTAC PLUS granulation in the management of severe chronic constipation. Total 450 patients were enrolled to receive a CONSTAC PLUS for maximum 60 days. Out of 450 patients, 33 were lost to follow up. The symptoms of constipation were evaluated by Longos Obstructed Defecation Syndrome (ODS) score system. Patients quality of life was assessed by the Patient Assessment of Constipation-Quality of Life Questionnaire and stool consistency were assessed by “Bristol stool form scale†before and after 15, 30 and 60 days. Analysis done for 417 patients. After treatment there was significant (p<0.005) improvement in defecation frequency per week. There was significant reduction in rectoperinieal pain and discomfort, straining intensity, average time spent on toilet for bowel evacuation and digitations score. Stool consistency were significantly (p<0.005) improved in all follow-up visits. Quality of life also significantly improved in all follow up visits. During study abdominal pain/cramping (n= 13/ 3.12%), bloating (n= 11/ 2.64%), diarrhea (n= 9/ 2.16%), and passing gas (n= 17/ 4.098%) adverse events were more commonly reported. All were treated by medical management. This result proves CONSTAC PLUS is an effective and safe herbal laxative formulation for severe chronic constipation

A novel four quadrant laser sphincterotomy for idiopathic severe anal stenosis

Anal stricture or stenosis, though uncommon, is disabling condition. It affects the quality of life due to pain, bleeding and difficulty in defecation, incontinence or increased frequency. It occurs when the normally pliable anoderm is replaced with fibrotic connective tissue, leading to an abnormally tight and inelastic anal canal. Mostly it occurs secondary to trauma, iatrogeny, inflammatory diseases, radiation or neoplasia. The treatment of anal stricture is generally considered to be difficult and various methods of treatment have been suggested. It is often unresponsive to conservative medical management. The surgical procedures such as dilatations and anoplasty are associated with significant complications which make it a difficult treatment challenge. Several good treatment options are available currently. Through this case, we report and explore a new medical treatment for anal strictures with four quadrant laser sphincterotomy. Resumo: A estritura ou estenose anal, embora incomum, é problema incapacitante. Essa condição afeta a qualidade de vida por causa da dor, do sangramento e da dificuldade de defecação, de incontinência ou aumento da frequência. A estenose anal ocorre quando o anoderma, normalmente flexível, foi substituído por tecido conjuntivo fibrótico, e o resultado é um canal anal anormalmente estenosado e inelástico. Na maioria dos casos, a estenose anal ocorre secundariamente a trauma, por causa iatrogênica, por doença inflamatória, radiação ou neoplasia. Em geral, se considera que o tratamento dessa condição é tarefa difícil, tendo sido sugeridos diversos métodos de tratamento. Com frequência a estenose anal não responde ao tratamento clínico conservador. Procedimentos cirúrgicos como as dilatações ou a anoplastia estão associados a complicações significativas, implicando difícil desafio terapêutico. Atualmente, o cirurgião conta com várias opções terapêuticas satisfatórias. No presente caso, relatamos e exploramos um novo tratamento clínico para estenoses anais, por meio da esfincterotomia a laser nos quatro quadrantes. Keywords: Anal stenosis, Anoderm, Laser sphincterotomy, Anal stricture, Anal canal surgery, Palavras-chave: Estenose anal, Anoderma, Esfincterotomia a laser, Estritura anal, Cirurgia de canal ana

A novel four quadrant laser sphincterotomy for idiopathic severe anal stenosis

Anal stricture or stenosis, though uncommon, is disabling condition. It affects the quality of life due to pain, bleeding and difficulty in defecation, incontinence or increased frequency. It occurs when the normally pliable anoderm is replaced with fibrotic connective tissue, leading to an abnormally tight and inelastic anal canal. Mostly it occurs secondary to trauma, iatrogeny, inflammatory diseases, radiation or neoplasia. The treatment of anal stricture is generally considered to be difficult and various methods of treatment have been suggested. It is often unresponsive to conservative medical management. The surgical procedures such as dilatations and anoplasty are associated with significant complications which make it a difficult treatment challenge. Several good treatment options are available currently. Through this case, we report and explore a new medical treatment for anal strictures with four quadrant laser sphincterotomy. Resumo: A estritura ou estenose anal, embora incomum, é problema incapacitante. Essa condição afeta a qualidade de vida por causa da dor, do sangramento e da dificuldade de defecação, de incontinência ou aumento da frequência. A estenose anal ocorre quando o anoderma, normalmente flexível, foi substituído por tecido conjuntivo fibrótico, e o resultado é um canal anal anormalmente estenosado e inelástico. Na maioria dos casos, a estenose anal ocorre secundariamente a trauma, por causa iatrogênica, por doença inflamatória, radiação ou neoplasia. Em geral, se considera que o tratamento dessa condição é tarefa difícil, tendo sido sugeridos diversos métodos de tratamento. Com frequência a estenose anal não responde ao tratamento clínico conservador. Procedimentos cirúrgicos como as dilatações ou a anoplastia estão associados a complicações significativas, implicando difícil desafio terapêutico. Atualmente, o cirurgião conta com várias opções terapêuticas satisfatórias. No presente caso, relatamos e exploramos um novo tratamento clínico para estenoses anais, por meio da esfincterotomia a laser nos quatro quadrantes. Keywords: Anal stenosis, Anoderm, Laser sphincterotomy, Anal stricture, Anal canal surgery, Palavras-chave: Estenose anal, Anoderma, Esfincterotomia a laser, Estritura anal, Cirurgia de canal ana

Laser pilonidotomy — a new approach in management of complex pilonidal sinus disease: an exploratory study

Background: The treatment of pilonidal sinus disease still remains challenging mainly because of multiple factors responsible for wound healing and its recurrence. With recent advances in surgical field, use of laser found to be an effective technique in the destruction of a pilonidal cyst. Laser Piolonidotomy is a new promising technique. Methodology: An exploratory study was planned with the Aim, to evaluate a new technique for the excision of pilonidal sinus. Objectives were to investigate its effectiveness in terms of operation time, healing time, and the duration of hospitalization, resumption of normal activity the degree of postoperative complications and rate of recurrence and patient’s satisfaction. All the patients with pilonidal sinus were categorized and laser pilonidotomy was planned for patients satisfying inclusion criteria. Data collected in pre-structured, pre-tested proforma and analyzed using SPSS. Results: Mean duration of Procedure was 33 min (SD = 11), mean duration of Hospital Stay was 12 h (SD = 3), resumption of normal activity within 4 days (SD = 2), mean duration for Complete Wound Healing by secondary intention 6 Weeks (SD = 1.25). Among complications, infection reported in 1.08%. The difference between the mean pre and post-operative VAS score was statistically highly significant (p < 0.0001). Recurrence rate was 3.24%. Success rate was 96.75% and Overall patient’s satisfaction was 97.84%. Conclusion: Laser Pilonidotomy is effective in destruction of a pilonidal cyst with good success rate, fewer complications and with high patient’s satisfaction. Resumo: Justificativa: O tratamento da doença do seio pilonidal ainda permanece desafiador, principalmente devido a vários fatores responsáveis pela cicatrização das feridas e sua recorrência. Com os recentes avanços no campo cirúrgico, o uso do laser mostrou ser uma técnica eficaz na destruição de um cisto pilonidal. A piolonidotomia a laser é uma nova técnica promissora. Metodologia: Foi planejado um estudo exploratório com o objetivo de avaliar uma nova técnica para a excisão de seio pilonidal. Os objetivos foram investigar sua eficácia quanto aos tempos de operação, de cicatrização, de internação e de retomada da atividade normal, além do grau de complicações pós-operatórias, a taxa de recorrência e o índice de satisfação do paciente. Todos os pacientes com seio pilonidal foram categorizados, e a pilonidotomia a laser foi planejada para os pacientes que satisfizessem os critérios de inclusão. Os dados foram coletados em forma pré-estruturada e pré-testada e analisados usando o SPSS. Resultados: O tempo médio do procedimento foi de 33 min (DP = 11), o tempo médio da internação hospitalar foi de 12 horas (DP = 3), o tempo médio de retomada da atividade normal foi de 4 dias (DP = 2) e o tempo médio de cicatrização completa por intenção secundário foi de 6 semanas (DP = 1,25). Entre as complicações, infecção foi observada em 1,08%. A diferença entre as médias do escore EVA pré e pós-operatório foi estatisticamente significativa (p < 0,0001). A taxa de recorrência foi de 3,24%. A taxa de sucesso foi de 96,75% e o índice de satisfação geral do paciente foi de 97,84%. Conclusão: A pilonidotomia a laser é eficaz na destruição de um cisto pilonidal com boa taxa de sucesso, menos complicações e com alta satisfação do paciente. Keywords: Pilonidal sinus, Pilonidal cyst, Sacrococcygeal pilonidotomy, Laser pilonidoplasty, Recurrent pilonidal sinus, Palavras-chave: Seio pilonidal, Cisto pilonidal, Pilonidotomia sacrococcígea, Pilonidoplastia a laser, Seio pilonidal recorrent

Neuromyelitis optica with Hashimoto′s thyroiditis: A new syndrome or just coincidence

Neuromyelitis optica (NMO) is an uncommon disease syndrome of the central nervous system that affects the optic nerves and spinal cord. NMO with endocrinopathies has been described as being unique to black Antillean and Afro-Brazilian women. We describe one case of NMO with hashimoto′s thyroiditis in a young female, probably first case report in India