A CLINICO.PATHOLOGICAL STUDY OF ANAL FISTULAE

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Anal Fbtuh R*lat of Llterature folds and protein- losing enteropathy- These patients had serologic, histologic, or cultrrre evidenoe of CMV infection, or all three. I- Clinical Presentation and sites of lnvolvement. Table L Clinical Featwes Suggesting Possible Gasuointestinel Cytomegalovirus Disease a) Hi d immunodeficiency syndrome : reclptent I theiaov or Can'c'er chemotherapy 3 Abdomlnal Darn Colities or bloodv diarrhea or both Acute abdorien c) ' Gastrointestinal lesions Esonhaqeal ulcer GastriiulcEr Gastric ulcer a- Mouth Painful etosions or ulcers (Marcusen and sooy,1985 ), enlarged, painful salivary glands (Pialoux et al, l99l), and odynophagia due to an epiglottic (Hinnant et al, 1986 ) or posterior pharyngeal ulcer (Laiwani et al, l99l). b- Esophagus A large, solitary, distal esophageal ulcer caused odynophagia or constant substerlral pain or both in AIDS patients (McDonald et al, 1985). Esopagnal strichue formation after healing with anti-CMV therapy has been described (Wilcox et al, 1990 ), c- Stomrch Epignsfiic pain, nanrsea, and vomiting (see Table l) (Iwasaki, 1987), Complications of CMV gasnic ulcers inolude bleeding (Allen et al, lgSllgastric outlet obstrucfion (Victoria et al, 1985), and perforation. d- Small Intestine Asymptomatic trarrsplant recipient wi th endoscopically normal duodenal mucosa (Franzin et al, l98l ) to a patient with progressive diarrhea followed by fatal perforation of a severely ulcerated mucosa (Fernandez et al, 1986). Terminal ileal disease may mimic Crohn disease clinically, and radiologically (Wajsman et al, 1989). Small-bowel erosions and ulcerations have been observed in a healthy adult with acute CMV infection (Spiller et al, 1988) and in an elderly patient with no apparent immune disorder (Spiegel and Schwabe, 1980). Cytomegalovirus ulceration of the appendix has occuned as acute appendicitis in AIDS patients (Lin et al, 1990) * 3 fr 34
AnalFbtula Review ofLiterature * e Colon: Diarrhea, hematochezia, urgency, tenesmus, and abdominal pain, often with associated constitutional symptomsuch as fever, malaise, anorexia, and weight loss (Frank and Raicht, 1984). The presentation can be acute (Tamura, 1973) or chronic (Frager et al, 1986). Massive acute bleeding has been reported (Goodman and porter, 1973), especially from cecal ulcers in transplant patients (Foucar et al, l98l) Colonic perforation has been described frequently (Gangahar et al, 1988). II- Diagnosis Table 2 Methods Used To Diagnose Gastrointestinal Ctomegalovirus Disease Acceptable and specificity svol( Uncertain sensi and specificitv rre of lesionschain reaction on tissue from lesion i* + * The best approaeh is to confirm the presence of CMV with histolo analysis and to nrle out other pathogens using standard techniques. a- Serologic Analysis Because of the high prevalence of IgC anti-CMV antibodies in most adults, this assay is not helpful as a diagnostic tool to detect CMV disease (Culpeper-Morgan et al, 1987) the presence of IgM_anti-CMV antibody - suggests recent infection but does nst establish the diagnosis of tissueinvasive disease (Merigan and Resta, 1990), b- Blood, Urine, Stool, and Oropharyngeal Culture A positive test result frorn blood, throat, or urine culhrre does not prove that gastrointestinal signs or symptoms are due to CMV disease nor does a negative culture from these sites rule out gastrointestinal CMV disease (Culpeper-Morgan et al, 1987). Quantitative polymerase chain reaction (PCR) assays on blood may be more useful than culture in predicting active CMV disease. c- Radiology Barium radiographs from patients with proved CMV disease have been published (Bafthazar et al, 1985). In the esophagus, the most corrmon finding is the distal, solitary ulcer, In stomach, thick gastric folds, antral narrowing, or ulcers, have all been described (Balthazar et al, 1985). Ileal narrowing r:esernbling Crohn disease has been observed (Wajsman et al, 1989). ln the colon, the raiographic findings can be focal or diffuse, and the mucosal changes may be superficial or may be deep ulcerations (Balthazar et al, 1985). These radiographic findings described above are nonspecific. 35
Page 1 and 2: 9ttV A CLINICO.PATHOLOGICAL STUDY O
Page 3 and 4: ABSTRACT The abscess-fistula sequen
Page 5 and 6: ACKNOWLEDGMENT I ,a f This work was
Page 7 and 8: List of Tables Table Table (l): Cli
Page 9 and 10: Fig. (12): Typei of Intersphincteri
Page 11 and 12: Anal Fhtula Inlroduction & Ain of W
Page 13 and 14: AnalFbtula Review of Literature Fb.
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Page 83 and 84: .Resu//s I + Fig 22: High power of
Page 85 and 86: tesz/rl I I t Fig 24: An immuno$tai
Page 87 and 88: Resrlts # Fig 28: An immunostaining
Page 89 and 90: Anal Fbtula .Rcsulrs The disfributi
Page 91 and 92: Anal Fbtula DJscussion DISCUSSION s
Page 93 and 94: Anal Fl$tula Dr'scusslon t Serum Cy
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Anal Fhtula Disczsslon * Further ve
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Anal Fbtula Summary SUMMARY The aim
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Anal Fbtula Summary t Further verif
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AnalFlrtula Relervnws Balthezar, 8,
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Anal Ftoh References Culpepper-Morg
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AnalFbtula References infection in
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AnalFbtuh Relerences Goldberg, S.M.
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AnalFlstula References Jackman, R.J
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Anal Flstula Refercnces Mercusen, D
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Anal Fbtuh References in patients w
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Anal'Flstula References Rubin, R.H.
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Anal Flstula , References Vasilevsk
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A CLINICO.PATHOLOGICAL STUDY OF ANAL FISTULAE

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