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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Anorectal disorders include a diverse group of pathologic processes that are frequently encountered in general medical practice but are poorly understood. The optimal management of anal pain, itching, bleeding, and incontinence is based on sound anatomic and pathophysiologic principles. Advances have been made in understanding the pathogenesis and management of four anorectal disorders frequently encountered by internists: hemorrhoids, fissures, pruritus, and incontinence.
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PMID:Common anorectal disorders. 638 55

Bowel habit, anal pain or discomfort, pruritus ani and faecal soiling have been assessed in 82 patients with uncomplicated, prolapsing haemorrhoids before and after successful treatment (improvement in rectal bleeding and haemorrhoidal prolapse) by haemorrhoidectomy or rubber band ligation. An age and sex-matched control group of patients without haemorrhoids was similarly assessed. The bowel habit of the haemorrhoid group was not different from that of the control population. Pain or discomfort, pruritus and faecal soiling were much commoner in the pretreatment haemorrhoid group, compared to controls. Treatments designed to abolish rectal bleeding and prolapse (the cardinal symptoms of haemorrhoids) also reduced the incidence of these three symptoms. Only anal pain or discomfort, however, was reduced to the incidence found in the control group. Haemorrhoidectomy and rubber band ligation appeared equally effective in controlling all three symptoms. It is concluded that anal pain or discomfort, pruritus ani and faecal soiling are common symptoms of uncomplicated haemorrhoids and that they are abolished in the majority of patients by successful treatment for rectal bleeding and haemorrhoidal prolapse.
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PMID:The importance of pain, pruritus and soiling as symptoms of haemorrhoids and their response to haemorrhoidectomy or rubber band ligation. 697 87

Fifty patients with first or mild second degree haemorrhoids were randomly allocated to sclerosant injection (26) or rubber band ligation (24). One year after treatment 24 injection and 22 rubber band ligation patients were assessed. All patients presented with rectal bleeding; injection relieved 14 and rubber band ligation relieved 17 of this symptom (N.S.). Three of seven patients with prolapsing haemorrhoids who had sclerosant injections and five of seven who had rubber band ligation were relieved of this prolapse. However, a further six patients in the injection group developed prolapse for the first time during the one year follow-up period (p less than 0.05). Rubber band ligation relieved anal pain in 10 out of 14 patients whereas injection relieved only one patient of this symptom (p less than 0.05). Neither treatment influenced pruritus ani or faecal soiling. Although rubber band ligation caused more treatment discomfort, it is an effective management for first and mild second degree haemorrhoids and it should be considered as the procedure of choice.
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PMID:Comparison of rubber band ligation and sclerosant injection for first and second degree haemorrhoids-- a prospective clinical trial. 704 18

A 63-year-old, Dutch, HIV-seronegative man presented with anal pain and itch of 6 months' duration, a perianal ulcer and a solitary colon ulcer. Crohn's disease was suspected; the patient was treated with corticosteroids, but later died. Autopsy revealed disseminated histoplasmosis, a fungal disease rare in the Netherlands. The patient had visited Honduras. This case report illustrates that disseminated histoplasmosis may mimic Crohn's disease leading to a delay in the diagnosis.
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PMID:[Generalized histoplasmosis due to endogenous reactivation of a latent infection in an HIV-seronegative man]. 762 32

From January 1988 to December 1993, we identified six men with minimally invasive (stage I) squamous cell carcinoma of the anus and 10 men with anal carcinoma in situ (CIS). Of the six patients with invasive carcinoma, four were infected with human immunodeficiency virus (HIV), including one with AIDS. Of the 10 patients with CIS, eight were infected with HIV, including four with AIDS. Anal pain and bleeding were the most common symptoms of minimally invasive anal cancer and anal CIS. Anal irritation, burning, or pruritus occurred more frequently in patients with CIS, whereas anal ulcers, masses, or abscesses were more frequent in patients with minimally invasive cancer. Several patients with CIS had a discrete area of leukoplakia in the anal canal or a pigmented plaque of the anus and anal canal. These lesions were not observed in patients with minimally invasive anal cancer. The symptoms and signs of early-stage anal cancer in men at risk for developing HIV infection or men infected with HIV often resemble those of other common anorectal diseases in homosexual men. Anal cancer in HIV-infected men is not limited to those individuals with AIDS.
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PMID:Clinical presentation of minimally invasive and in situ squamous cell carcinoma of the anus in homosexual men. 852 51

Anorectal symptoms and complaints are common and may be caused by a wide spectrum of conditions. Although most conditions are benign and may be successfully treated by primary care practitioners, a high index of suspicion for colorectal cancer should be maintained, and all patients should be appropriately investigated. Inspection, palpation and anoscopic examination using an Ive's slotted anoscope provide adequate initial assessment. Pruritus ani usually represents a self-perpetuating itch-scratch cycle and is uncommonly due to infection. The history, as well as the physical examination, can distinguish anal pain due to hemorrhoids, fissure, abscess, cancer or proctalgia fugax. The most frequent causes of rectal bleeding are hemorrhoids, fissures and polyps. Diagnoses associated with difficulty in passing stool can range from constipation to fecal incontinence.
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PMID:Common anorectal conditions: Part I. Symptoms and complaints. 1143 Apr 54

The purpose of the present study was to determine the value of circular hemorrhoidectomy (procedure for prolapse and hemorrhoids [PPH]) on the basis of data collected prospectively during the initial experience of a group of Latin American surgeons. Between 2000 and 2001, PPH was performed using a circular stapler in 177 patients who had third- and fourth-degree hemorrhoidal disease. The average age of the patients was 47.7 years (range 26 to 85 years). Anal bleeding was the most common preoperative complaint (93.2%) followed by anal pain (60.2%), anal itching (43%), and constipation (41%). Hemorrhoids were classified as third degree in 132 patients (74%) and fourth degree in 45 patients (25.4%). Skin tags were detected in 86 patients (48.8%) and rectocele in 14 patients (7.9%). Data collected included patient demographics, type of anesthesia, and specific details of the surgery such as duration of the operation, distance from the staple line to the dentate line, need for complementary hemostasis, and any unexpected occurrences. Postoperative data collected included the degree of pain, which was evaluated on the basis of the type and dosage of analgesics required, laxative consumption, and the presence of bleeding, fever, urinary retention, or hematomas. Each patient completed a written questionnaire addressing these events. Patients returned for follow-up visits on days 7, 15, 30, and 90. Responses to pain, bleeding, fever, anal continence, recurrence of hemorrhoids, and level of satisfaction were compiled. The duration of the procedure ranged from 6 minutes to 2 hours (average 23 minutes), and most operations lasted no more than 20 minutes, with the exception of one that lasted 2 hours because of intraoperative bleeding. Intraoperative problems were minor. An additional one or a few sutures were required in 58.7% of patients to achieve perfect hemostasis. In 128 patients (72.3%) the hospital stay was less than 24 hours. Same-day surgery was chosen for 37 patients (20.9%). Pain was controlled with analgesia only using one to six doses of oral dipirona in 126 patients. Five patients were readmitted to the hospital: four for control of bleeding and one for conventional hemorrhoidectomy due to an acute episode of external hemorrhoidal thrombosis. At day 30, patients rated the efficacy of the procedure in alleviating preoperative symptoms as follows: 77.5% excellent; 16% good; 5.3% average, and 1.2% poor. At 3 months postoperatively no patient had had a recurrence of hemorrhoidal prolapse, and there were no instances of stenosis or anal incontinence. Surgeons also rated the efficacy of the procedure as excellent in 75%, good in 19.8%, average in 4.7%, and poor in 0.6%. With proper selection of patients and adequate stapling technique, stapled hemorrhoidectomy may be considered safe; it is easily learned, has a satisfactory degree of pain, and is well accepted by both patients and surgeons.
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PMID:Stapled hemorrhoidectomy: initial experience of a Latin American group. 1312 62

Little is known about the prevalence of rectal chlamydial infection amongst men who have sex with men (MSM). Previous studies using culture methods reported this to be between 4-6%. The emergence of nucleic acid amplification tests has significantly increased the sensitivity and specificity for chlamydial detection, making it possible to estimate the prevalence of rectal infection more accurately. A prospective cross sectional study involving 443 MSM who were screened for sexually transmitted infections (STIs) between May 1999 and January 2002. Rectal swabs for chlamydiae were obtained in addition to specimens for routine STI screening. Rectal chlamydiae were detected by ligase chain reaction (LCR) utilizing the Abbott LCX Amplicor with confirmation by COBASE amplicor for the majority of cases. Those with rectal chlamydial infection were treated with azithromycin. The characteristics of men with rectal chlamydial infection were compared with those who were not infected at this site. Rectal chlamydia was detected in 32 (7.2%) of 443 patients. Those with rectal chlamydial infection were more likely to have rectal symptoms (12/32) or having a partner with confirmed chlamydial (2/32) or gonococcal (3/32) urethritis than those MSM without rectal chlamydial infection. They were also more likely to have a history of receptive anal sex (25/32) in the previous three months compared to those MSM without rectal chlamydial infection (263/411). The most common symptoms of patients with rectal chlamydial infection were pruritus ani and peri-anal pain. Eight (25%) of those with rectal chlamydial infection were known to be HIV seropositive. Rectal chlamydial infection is common amongst MSM and is effectively diagnosed by LCR. The test should be included in the routine STI screening offered to MSM.
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PMID:The prevalence of rectal chlamydial infection amongst men who have sex with men attending the genitourinary medicine clinic in Edinburgh. 1560 99

Ectopic gastric mucosa has been described at various locations of the body, including all levels of the gastrointestinal tract. However, this finding is rare in the rectum and anus, with 38 reported cases. In only six cases, including the present one, has the heterotopic tissue been located within 2 cm of the dentate line. We report a case of gastric heterotopia discovered in a 21-year-old male who presented with anal pain and pruritus. Flexible sigmoidoscopy demonstrated an anal polyp, and biopsy confirmed fundic-type gastric tissue. A (99m)technetium-pertechnetate scan confirmed increased uptake in the anus. After minimal clinical improvement with proton-pump inhibitors, the patient underwent local surgical excision and remains symptom-free at a follow-up of 9 months. We review the potential etiologies, clinical manifestations, treatment options, and patient outcomes.
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PMID:Heterotopic gastric mucosa of the anus: a case report and review of the literature. 1532 7

Hemorrhoid is a common anal problem in our country that is currently treated by many different methods. Three modalities were assessed in a randomized prospective trial in which 848 patients with a second-degree hemorrhoid were treated by rubber band ligation (470 patients), injection sclerotherapy (280 patients), or cryosurgery (98 patients). The effectiveness of each method was assessed clinically at 3, 6, 9, and 12 months after initial treatment, and determined by improvement in presenting symptoms. All patients complained of rectal bleeding and prolapse of the hemorrhoid on defecation, but only 69% had anal pain and 14% suffered from pruritus ani. Rubber band ligation was found to be superior to the other methods, and displayed statistical significance when compared to injection sclerotherapy and cryosurgery.
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PMID:A comparative study of different treatments of hemorrhoids. 1758 60


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