1/7. 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).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Perianal and vulvar Crohn's disease presenting as suspected abuse.Misdiagnosis of sexual abuse may arise in cases of vulvar and/or perianal diseases such as lichen sclerosus et atrophicus, Behcet's syndrome, bullous diseases, contact dermatitis, or neoplastic lesions. We present the case of a 7-year-old girl who was referred by her general paediatrician to the local hospital for perianal fissures and swelling of the labia majora. A report to the judicial authorities was made, for suspected sexual abuse, and the patient was transferred to the department of paediatric surgery. Here, histopathologic examination of vulvar and rectal biopsies revealed multiple non-caseating and non-confluent epithelioid-gigantocellular granulomas, consistent with a diagnosis of Crohn's disease, with cutaneous involvement of the genitalia. In cases of suspected sexual abuse, examination of children should be performed by a specialist in legal medicine in collaboration with a gynaecologist or paediatric surgeon. If the patient is hospitalised and the question of protection does not arise, physicians should exclude dermatological diseases before reporting to the judicial authorities.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Perianal cellulitis. Cutaneous group A streptococcal disease.Five case reports of perianal cellulitis caused by group A beta-hemolytic streptococci are presented. These reports illustrate delays in diagnosis and therapy of this condition that may present as chronic diaper dermatitis, perirectal fissures, painful defecation, fecal hoarding behavior, or proctocolitis. One patient had associated guttate psoriasis. In children especially, guttate psoriasis should alert physicians to culture perirectal as well as pharyngeal sites for group A streptococci.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Cryptococcal anal ulceration in a patient with AIDS.We report the case of an African patient with acquired immune deficiency syndrome (AIDS) who had a chronic cryptococcal rectal abscess with anal fistula and a disseminated neurologic and bony fungal disease, associated with pulmonary infiltration due to pneumocystis carinii. The anal lesion was surgically excised because of failure of the medical treatment. Although clinical intestinal cryptococcal involvement is quite rare, the experience here recorded should draw physicians' attention to the possibility of an insidious disseminated disease in AIDS patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Septic complications of hemorrhoidal banding.rubber band ligation is an efficacious and cost-effective alternative to conventional hemorrhoidectomy for symptomatic internal hemorrhoids. Even though the well-recognized complications of bleeding and thrombosis occur infrequently, far more serious septic complications have only recently been described, as evidenced in five of our patients: four cases were serious enough to necessitate surgical intervention, and one patient died. pain followed by urinary dysfunction with or without toxic symptoms should alert the physician to the probability of localized perianal or systemic sepsis. Acute awareness of these rare but potentially life-threatening complications and immediate aggressive treatment is mandatory if death is to be prevented. rubber band ligation of internal hemorrhoids need not be abandoned; however, the indications should be clear, the technique mastered, and a close patient follow-up maintained.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Gastrointestinal manifestations of epidermolysis bullosa in children.The medical and surgical management of the chronic and recurrent esophageal and anal lesions of recessive dystrophic epidermolysis bullosa pose challenging problems for the physician. Various therapeutic approaches are discussed, and the case histories of four problem patients are reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Outcomes of anorectal disease in a health maintenance organization setting. The need for colorectal surgeons.PURPOSE: The current trend in health delivery is managed care, in which the primary care provider (PCP) manages patient care and triages specialty referrals. It has not been established, however, that PCPs can accurately diagnose, treat, or triage anorectal disorders. MATERIALS AND methods: A retrospective study was undertaken at a health maintenance organization that hired a colon and rectal surgeon. charts of the first 100 consecutive consultations for anorectal complaints were analyzed for accuracy of diagnosis and appropriateness of care. RESULTS: Correct diagnoses were made by 45 of 85 (53 percent) PCP physicians, 6 of 15 (40 percent) PCP physician assistants, and 8 of 15 (53 percent) general surgeons. A delay to diagnosis or appropriate treatment occurred in 25 patients (25 percent), resulting in an adverse outcome in 15 people. Of these, five complications were caused by delayed diagnosis, and ten patients had symptoms that persisted from 5 months to 14 years (mean, 4.5 years). Seven unnecessary referrals to a gastroenterologist resulted in three unnecessary colonoscopies. Of 19 patients evaluated by a general surgeon, 4 had inadequate/inappropriate operations, 5 were untreated because of misdiagnosis, 3 correctly diagnosed were untreated, 3 had inappropriate follow-up, 1 was referred to a gastroenterologist, and 2 were advised to have appropriate treatment. SUMMARY: The PCP correctly diagnosed anorectal disorders in 51 percent of cases and referred patients promptly 75 percent of the time. Of the 25 percent with delay, 60 percent experienced a complication of persistent symptoms. Fifteen of 19 (79 percent) patients seen by a general surgeon were inappropriately managed.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |