Posts Tagged ‘Anus’

What is meant by Hemicorporectomy?

In medicine (surgery), hemicorporectomy can also be called as translumbar amputation and “halfectomy”.

- It is a radical surgery in which the body below the waist is amputated that transects the lumbar spine.
- Hemi is generally used to refer to one of two sides like e.g., hemiplegia, which affects the arm and leg on one side of the body.
- The first hemicorporectomy was attempted by Charles S. Kennedy in 1960.

This includes the removal of:
- legs,
- the genitalia (internal and external),
- urinary system,
- pelvic bones,
- anus,
- rectum.

What kind of patients is recommended to undergo this procedure?
- It is a severely mutilating procedure recommended only as a last resort for patients.
- It is suggested to the patients with severe and potentially fatal illnesses like osteomyelitis, tumors, severe traumas and intractable decubiti in, or around, the pelvis.
- Cancer patients who need:
1. Extended radical mastectomy.
2. Radical gastrectomy.
3. Pancreatectomy.
4. Pelvic exenteration.
5. The ‘Commando Operation’ (tongue, jaw and neck dissection).
6. Bilateral back dissection.
7. Hemipelvectomy.
8. Hemicorporectomy or translumbar amputation.

Indications
- The operation is most often performed to treat spreading cancers related to that of the spinal cord and pelvic bones.
- Trauma affecting the pelvic girdle (“open-book fracture”).
- Uncontrollable abscess or ulcers of the pelvic region (causing sepsis).
- Other locally uncontainable conditions.

The Surgical Procedure
- It is often done in two stages.
- It is also possible to conduct the surgery in one stage.
- The first stage is the discontinuation of the waste functions in colostomy (rectum) and ileal conduit (bladder).
- The second stage is the amputation.

What are the points to be considered when undergoing this procedure?
- With the removal of almost half of the circulatory system, cardiac function needs to be closely monitored.
- A new blood pressure set-point develops.
- Removal of large parts of the colon can lead to loss of electrolytes.
- A calculated measurements of renal function (such as the Cockroft-Gault formula) are unlikely to reflect actual activity of the kidney.

Post Treatment
- Extensive physiotherapy and occupational therapy are necessary.
- The design and construction of bucket prosthesis.

Prosthetic
- Following a hemicorporectomy, patients are fitted with a socket-type prosthetic often referred to as a bucket.
- Early bucket designs often presented significant pressure problems for patients.
- New devices have incorporated with an inflatable rubber lining composed of air pockets.
- These evenly distribute pressure based on the patient’s motions.
- Two openings at the front of the bucket create space for the colostomy bag and the ileal conduit.

Postoperative management requires
- Particular attention to fluid replacement,
- Temperature control,
- Pulmonary care.

Long-term management issues involve:
- Hypertension,
- Weight gain,
- Temperature control,
- Stoma management,
- Skin care

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Anal Cancer – Some information about treatments

Anal cancer can be fatal if not detected in its early stages. Broadly there are different types of treatment for people suffering from anal cancer. Clinical trials and standard treatments are used to cure people of anal cancer. However clinical trials are treatments that are used on patients who are suffering with anal cancer and if the treatment works and produces good results it will become a standard treatment. Clinical trials cannot be taken by all patients, only people who have been recently diagnosed with the disease and have not undergone any standard treatment can make use of clinical trials.
Radiation Therapy: Radiation therapy is one of the most commonly used forms of treatment used to kill cancer cells. It makes use of high energy x-rays or any other radiation. Radiation therapy is of two types: Internal radiation therapy and external radiation therapy. In External radiation therapy radiation from outside the body is used to send radiation from a machine towards the cancer. Internal radiation therapy involves using a radioactive substance sealed in needles, seeds are directly placed near or into the cancer cells. The type of radiation therapy is decided depending upon the stage of the cancer.
Chemotherapy: Chemotherapy is a treatment for cancer that uses drugs to stop the growth of cancer cells by killing them or by stopping them from dividing. Chemotherapy can be taken orally or be injected into a muscle or vein. Systemic chemotherapy ensures that through this method the drugs are transported to the cancer cells through the blood stream. Regional chemotherapy is the process where the drugs are placed directly into the any organ or cavity of the body. In this way the drug affects only the select area.

Surgery:
Local Resection: Is a process which involves cutting of the tumor from the anus with some healthy tissue around it. This process can be used if the cancer has not spread and is small. Tumors that form in the lower part can be removed by this method of surgery
Abdominal Resection: This is a surgical procedure whihc requires the anus, a part of the sigmoid and the rectum to be removed with an incision in the abdomen. A Colostomy is performed so that the waste from the body can be collected in a bag outside the human body.

In case a person is suffering from human immunodeficiency virus, there is a chance that the cancer treatment may weaken him further and affect the treatment. And that is why patients who are suffering from human immune deficiency virus are treated with lower doses and lesser radiation.
A number of new treatments are being tested in clinical trials everyday. Radiosensitizers make tumor cells sensitive to radiation therapy. On combining the two the radiation therapy can be more effective. However clinical trials are just tests and they are not definite treatments, therefore patients who do choose to participate in these trials should consider all the possibilities before they do so. However there is no sure way of finding out if a clinical trial will be effective, but one can take solace in the fact that many of the standard treatments today were once tried clinically.
Patients can choose to be a part of clinical trials at any time. It does not matter if they have already undergone a standard treatment. They can choose to participate in a clinical trial before, during or after standard treatment. However there are certain clinical trials that will not accept patients who have received standard treatment. On the other hand some will accept patients who have undergone standard treatment but have seen no improvement in their condition. And there are other types of clinical treatments that stop the cancer from recurring and they also reduce the side effects of the treatment.

Anal Cancer Tests – PAP smear test

The PAP smear test has helped save a number of lives. It has been one of the best ways to test cervical cancer amongst women and has served as a lease for life for those who have detected their cancer at an early age. The anal papilloma screening also known as an Anal PAP can prove to be as effective is detecting anal cancer amongst men.
It is being touted as the best way for men who are straight or bisexual to check whether they may be inflicted by the deadly condition. It is very similar to the exam that is conducted for women. It requires a collection of cells from the rectum and anus of the patient at first. These cells are then examined under a microscope to check if they have undergone any structural changes. If there are any changes there may be reason to worry, however it is good as it is an indicator that proper treatment should be started at the earliest.
The Anal PAP procedure is absolutely painless, quick and very simple. A Dacron swab is used to collect cell samples around the area of the rectum and anus. The anal canal is swabbed off some cell samples to continue with analyzing the change in cell structure. Once the cell samples are collected they are sent to a lab where technicians examine the cells with the help of a microscope and try to pin point changes in the cell structure that indicate cancer. The results however may take a few days.
If you are experiencing the symptoms of anal cancer and your doctor has advised you to go in for an anal PAP, you may have to pay attention to the following to ensure your tests come out right. A day prior to the anal PAP you should practice the following don’ts :
a) Do not indulge in anal sex
b) Do not put any kind of ointments, creams, medications or lubricants in or around your anus
c) Stay away from sex toys and do not get excited 24 hours before your examination
d) Do not take enemas or douche
It is essential that one stays abreast of one’s health and therefore one should not wait until it’s too late to get an anal PAP done. An exam once in every three years can help detect and treat the cancer at an early age. In case there is a certain abnormality that surfaces as a part of the test the supervising physician can take care of these abnormalities by suggesting various non surgical treatments. A few of them are listed below:

Imiquimod: The abnormality detected can be treated with a topical agent called imiquimod. However this may have limited effect as it tends to rub off easily.
Onyx-015: This procedure is still under clinical trials, however it is said that this recombinant adenovirus has the power to kill the cells in the anal cavity that are infected with HPV.
Therapeutic Vaccines: Your physician will only recommend this route to treat the abnormality if you have a strong immune system.
These are just a few treatments that your physician may advise if some abnormality is detected. However you should ensure that you undergo an anal PAP once every three years if you want to stay healthy for a longer period of time by early detection and treatment of a condition that can take away precious years from your life.

So go in for regular examinations and checks and stay careful at all times. Make sure the physician you consult is the best and can offer you only the best advise and treatments.