Aluminum potassium sulfate and tannic acid injection (ALTA) is a useful and less-invasive treatment for internal hemorrhoids. However, it is not a treatment option for external hemorrhoidal diseases, including mixed hemorrhoids. Distal hemorrhoidectomy with ALTA injection involves surgical resection of external piles, followed by injection therapy on internal piles. We report technical details and the short-term results of this procedure in patients with mixed hemorrhoids. Seventy-two patients with mixed hemorrhoids treated between 2010 and 2011 were included. The main outcome measures were the short-term response and complication rates. At 28 days after surgery, the disappearance rate of prolapse was 100%. Three patients (4%) had postoperative complications, all minor in nature. No prolapse recurrence was observed within a median follow-up period of 6 months. Distal hemorrhoidectomy with ALTA injection appears to be a promising treatment option for patients with mixed hemorrhoids.

These findings provide evidence to support the advantages of helical CT cholangiography in relation to operative time, conversion, and procedure-related preoperative complications.

Purpose: This study aimed to report clinical data and recurrence rates in patients with anterolateral low fistulas who underwent open fistulectomy with sphincter fixation. Methods: The study group consisted of 133 consecutive patients with anterolateral, low intersphincteric, or low trans-sphincteric fistulas who had undergone open fistulectomy with sphincter fixation between January 2006 and December 2010. This procedure involves complete removal of the fistula tract by incision of anal sphincters, followed by fixation of the sphincter muscles. Results: Success was achieved in 127 (95.5%) patients with a median follow-up time of 12 months. Anal fistula recurred in 4 cases (3%). Non-healing fistula with persistent anal discharge developed in 2 patients. Maximal resting pressure, but not maximal squeeze pressure, was significantly decreased after surgery. Five patients (4%) developed temporary anal incontinence after surgery. Conclusions: Open fistulectomy with sphincter fixation was effective for the management of patients with anterolateral low fistula in this study. The high success rate suggests that this procedure is a reasonable option in this group of patients.

A 67 year old Japanese woman who had been suffering from general fatigue was diagnosed as having metastasis of signet-ring cell carcinoma of the bone marrow from a biopsied specimen. A clinical effortive search to the systemic organs revealed a tumor of 4 x 3 cm in size in the lower part of her left breast, which was subsequently diagnosed as the primary site histopathologically. The patient was immediately treated surgically, however, her general condition generally deteriorated and she expired 5 months after the operation. Autopsy revealed dissemination of tumor cells in the bone marrow, bilateral pleura, and soft tissue around the operated site. The autopsy additionally revealed squamous cell carcinoma of keratinizing type in the uterine cervix and well differentiated tubular adenocarcinoma in the gallbladder. A review of the literature revealed this case to be the first reported case of triple cancers including signet ring-cell carcinoma of the breast, proven by autopsy in Japan.