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Autoimmunity following COVID-19 vaccination has been reported. Herein, a 79-year-old man with clinical and immunological features of autoimmune hepatitis type 1 after ChAdOx1 nCoV-19 vaccination is presented. Clinical manifestations rapidly remitted after the instauration of immunomodulatory management. This case, together with a comprehensive review of the literature, illustrates the association between COVID-19 vaccines and the development of autoimmune conditions.

Oncologic resection of rectal cancer has been reported to be associated with a significant rate of fecal incontinence (FI). The risk is greater in patients with a resection less than 6-8 cm from the anal verge [1]. Sacral nerve stimulation (SNS) has been advocated as a safe and effective therapy for severe FI and shown to be associated with minimal morbidity [2]. In patients with FI after anterior resection (AR), SNS is has been used in few cases, with varying results [1,3].Between 2006 and 2009, four patients (one male, three female), with severe FI following neoadjuvant therapy and AR performed for rectal cancer, were treated in our hospital with SNS. The median age was 65.5 years (range 49-73 years). All patients had undergone chemoradiation before the operation. Total mesorectal excision and longitudinal coloplasty had been performed during the operation in all patients. The mean distance of the anastomosis from the anorectal ring was 5 cm (range 2-8 cm). The median history of FI following AR was 26.5 months (range 25-28 months). None presented tumor recurrence, local or distant. The incontinence status was classified according to the Wexner score [4].All patients were treated with conservative treatment, including drugs, constipating diet and biofeedback physiotherapy for 2 years. Before surgery, in all patients, anorectal manometry and endoanal ultrasonography were performed (Table 1). The percutaneous test stimulation was performed under general anesthesia. The response of S2-S4 was tested on both sides. If contraction of the anal sphincters could be obtained by SNS, percutaneous electrodes (Medtronic Ò 3050; Medtronic, Minneapolis, MN, USA) were implanted. The patients were subsequently tested by SNS for a 4-week period. Patients who became candidates for permanent implantation based on an improvement of their continence received the permanent stimulation generator (INTERSTIM II, 3058; Medtronic, Minneapolis, MN, USA) under general anesthesia. Differences were analyzed by the Wilcoxon test for paired data.All patients tested had contraction of the anal sphincters during the SNS 4-week test period. All patients had least a 50 % reduction in episodes of incontinence and were given a permanently implanted system. The Wexner score fell from a median score of 15.5 before SNS to 5.5 during permanent stimulation (p \ 0.005). There were no significant differences in sphincter pressures measured by anal manometry. The patients with associated urinary incontinence presented improvement in their symptoms. There was no cessation of clinical response during the follow-up, and no complications were observed.After colorectal or coloanal anastomoses at a lower location, about 30-60 % of patients develop anal dysfunction due to the loss of the rectum and internal sphincter. These patients develop clinical symptoms and signs, such as anterior resection syndrome, which includes stool frequency, urgency, fragmentation and soiling. These symptoms usually disappear approximately 1 year postoperatively [5]. Our results of SNS i...

Background: chronic anal fissure is one of the most frequent proctological disorders in Western populations. Open lateral internal sphincterotomy is one of the therapeutic options accepted as the treatment of choice for chronic anal fissure, since it reduces the hypertonia of the internal anal sphincter (the main etiopathogenic mechanism of fissures), decreases anal pain, and allows the fissure to heal. Material and methods: we carried out a prospective study of 120 patients operated on for chronic anal fissure with open sphincterotomy under local anesthesia at our Proctology Outpatient Unit from 1998 to 2001. No preoperative studies, bowel preparation, or antibiotic prophylaxis were carried out. All patients were followed up after 1 week, 2 months, 6 months, and 1 year, and underwent an anal manometry before and after surgery. Results: early complications: 3 hematoma-ecchymosis of the wound (2.5%), 3 self-limited hemorrhage events (2.5%). No hemorrhoidal thrombosis, fistulas, or perianal abscesses occurred. Fissures recurred in nine patients (7.5%) within one year. The initial rate of incontinence of 7.5% at two months dropped down to 5% at six months. The mean resting pressure (MRP) in incontinent patients was lower than in continent patients (55±7 mmHg versus 80.7 ± 21 mmHg). The difference in mean squeeze pressure (MSP) between incontinent patients and continent patients was not statistically significant. Conclusions: open sphincterotomy under local anesthesia has a long-term rate of healing and a morbidity rate similar to other techniques. It may therefore be considered an effective treatment for chronic anal fissure.

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