Re: Any Dr. Federico Guercini patients?

In article <_jQie.787100$w62.579696@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx>,
petesworkshop@xxxxxxxxxxxxxx says...
>
>jrh...How in the world would you ever get a doctor to agree with what you
>recommended below. He or she would dismiss you and toss you out on your
>ear. My new primary doctor, who I just asked for prednisone (and he
>refused - it's in one of my posts above) immediately sent me a certified
>letter saying he was dropping me and didn't even give me a reason why (my
>heart fell to my feet, since I am already totally distraught with my current
>prostatitis problem). I immediately called his office, and after insisting
>to talk to him (it is very rare if you can get a doctor to talk to you on
>the phone anymore), he got on the phone and told me he dropped me because he
>thought I was trying to force him to give me the prednisone against his
>training. I humbly apologized and begged for his forgiveness (because I
>really did like him) and he agreed that it is was a misunderstanding and
>said he would forget the certified letter and keep me as a patient. I have
>to have a primary (in case I get bronchitis, etc), and I just lost my other
>one since he left his practice, and I can't take any more doctors right now.
>
>I thought this new primary doctor (only been to him 3 times - foreign decent
>but spoke good English, and very friendly) was the nicest doctor I have ever
>been to and I told him that during our first meeting. I have been to over 75
>doctors in my life and most of them are prima donnas, who won't call you by
>your first name and you are just a chart to them, and who don't respect your
>right to study or research your disease, and they will dismiss you quickly
>if you are not careful how you word things to them, especially anything that
>may imply you know more than they do). This new doctor was not like that -
>he called me Peter when he came in the room and we had a very relaxed talk
>and he said the patient always comes first when I told him you have to be
>able to communicate with your doctor, and he said the patient has every
>right to study their disease or condition. So I really liked this guy and I
>felt I lucked out. So you can imagine how I felt when I got the certified
>letter, especially after having the worst time of my life with this
>prostatitis problem. Anyway I salvaged it, which means he must be a pretty
>good guy (most doctors would never reverse their decision if they dropped
>you, and most people would not want to go back anyway - but that is not the
>case here). I have been dropped by doctors, and dropped other doctors on my
>own in the past due to personality conflicts. The bitch is they all band
>together in one group (5 or 6 doctors), so when when you lose one you lose
>them all, and then you may have to go to the nearest city for another one
>(especially for the specialists).
>
>My point in writing that long explanation is that there is no way any doctor
>in the world would let you come into his/her office and give him/her the
>diagnostic procedure you recommended below. First of all they wouldnt do it
>themselves- it would have to be done in a hospital/lab environment probably
>by some technician, and the doctor would have to spell it out what to do.
>How the hell did you have this done and what particular type of bacteria or
>fungus or whatever were you looking for and what did they find.

Looking for something established medicine has not yet discovered.
"They" did not find anything, because "they" did not look.
If one had an anorectal problem like a fistula, impacted or ruptured
anal gland, or a fungal abscess, it would seem logical to expect to
see some evidence of it in anorectal secretions.

Fungi are present in the intestiona tract, and they are necessary for
digestion. A search of the internet will find little information
on the subject. So even if the test were done and fungi was found,
how would the lab know if it was abnormal? Red or amber would
be blood or clotting factor and I believe would indicate a problem.

The current diagnostic procedure for this type of problem from

eMedicine World Medical Library

---------------------------------------------------------------
Perianal Abscess
Last Updated: January 3, 2003
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Email to a Colleague
Synonyms and related keywords: anal abscess, perianal abscess, anorectal
abscess, ischiorectal abscess, perianal fistula, digital rectal examination,
DRE

AUTHOR INFORMATION Section 1 of 11 Click here to go to the
next section in this topic
Author Information Introduction Indications Relevant Anatomy And
Contraindications Workup Treatment Complications Outcome And Prognosis Future
And Controversies Pictures Bibliography

Author: Andre Hebra, MD, Clinical Associate Professor of Surgery, Department
of Surgery, University of South Florida, All Children's Hospital

Coauthor(s): Patrick B Thomas, MD, Staff Physician, Department of Surgery,
Medical University of South Carolina; Michael DeWolfe, BS, BA, Medical
University of South Carolina

Andre Hebra, MD, is a member of the following medical societies: Alpha Omega
Alpha, American Academy of Pediatrics, American College of Surgeons, American
Medical Association, American Pediatric Surgical Association, Association for
Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical
Association, Southeastern Surgical Congress, and Southern Medical Association

Editor(s): Marc D Basson, MD, PhD, Chief of Surgery, John D Dingell VA Medical
Center, Professor of Surgery, Department of Surgery, Wayne State University
School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor,
Pharmacy, eMedicine; Amy L Friedman, MD, Chief of Liver Transplantation
Services, Assistant Professor, Department of Surgery, Division of Organ
Transplantation and Immunology, Yale-New Haven Hospital, Yale University
School of Medicine; Paolo Zamboni, MD, Chair of Surgical Methodology,
Assistant Professor, Department of Surgical, Anesthesiological, and
Radiological Sciences, University of Ferrara Medical Center, Ferrara, Italy;
and John Geibel, MD, DSc, Director, Professor, Department of Surgery and
Cellular Molecular Physiology, Yale-New Haven Hospital, Yale University School
of Medicine
INTRODUCTION Section 2 of 11 Click here to go to the previous
section in this topic Click here to go to the top of this page Click here to
go to the next section in this topic
Author Information Introduction Indications Relevant Anatomy And
Contraindications Workup Treatment Complications Outcome And Prognosis Future
And Controversies Pictures Bibliography

Perianal abscess represents an infection of the soft tissues surrounding the
anal canal, with formation of a discrete abscess cavity. The severity and
depth of the abscess are quite variable, and the abscess cavity frequently is
associated with formation of a fistulous tract. For that reason, both perianal
abscess and perianal fistula are discussed in this article.

Problem: Anorectal abscesses originate from infection arising in the
cryptoglandular epithelium lining the anal canal. The internal anal sphincter
is believed to serve normally as a barrier to infection passing from the gut
lumen to the deep perirectal tissues. This barrier can be breached through the
crypts of Morgagni, which can penetrate through the internal sphincter into
the intersphincteric space. Once infection gains access to the
intersphincteric space, it has easy access to the adjacent perirectal spaces.
Extension of the infection can involve the intersphincteric space,
ischiorectal space, or even the supralevator space. In some instances, the
abscess remains contained within the intersphincteric space. The variety of
anatomic sequelae of the primary infection is translated into variable
clinical presentations.

Frequency: The peak incidence of anorectal abscesses is in the third to fourth
decades of life. Men are affected more frequently than women, with a
male-to-female predominance of 2:1 to 3:1. Approximately 30% of patients with
anorectal abscesses report a previous history of similar abscesses that either
resolved spontaneously or required surgical intervention. A higher incidence
of abscess formation appears to correspond with the spring and summer seasons.
While demographics point to a clear disparity in the occurrence of anal
abscesses with respect to age and sex, no obvious pattern exists among various
countries or regions of the world. Although suggested, a direct relationship
between bowel habits, frequent diarrhea, and poor personal hygiene and the
formation of anorectal abscesses remains unproved.

The occurrence of perianal abscesses in infants also is quite common. The
exact mechanism is poorly understood but does not appear to be related to
constipation. Fortunately, in infants this condition is quite benign and
rarely requires any operative intervention other than simple drainage.

Etiology: Perirectal abscesses and fistulas represent anorectal disorders
arising predominately from the obstruction of anal crypts. Infection of the
now static glandular secretions results in suppuration and abscess formation
within the anal gland. The abscess typically forms initially within the
intersphincteric space and then spreads along adjacent potential spaces.

Pathophysiology: Perirectal abscesses and fistulas represent anorectal
disorders that arise predominately from the obstruction of anal crypts. Normal
anatomy demonstrates anywhere from 4-10 anal glands drained by respective
crypts at the level of the dentate line. Anal glands normally function to
lubricate the anal canal. Obstruction of anal crypts results in stasis of
glandular secretions and, when subsequently infected, suppuration and abscess
formation within the anal gland results. The abscess typically forms in the
intersphincteric space and can spread along various potential spaces. Common
organisms implicated in abscess formation include Escherichia coli,
Enterococcus species, and Bacteroides species; however, no specific bacterium
has been identified as a unique cause of abscesses. Less common causes of
anorectal abscess that must be considered in the differential diagnosis
include tuberculosis, cancer, Crohn disease, trauma, leukemia, and lymphoma.

Clinical: The classic locations of anorectal abscesses listed in order of
decreasing frequency are as follows: perianal 60%, ischiorectal 20%,
intersphincteric 5%, supralevator 4%, and submucosal 1% (see Image 1).
Clinical presentation correlates with the anatomical location of the abscess.

Patients with perianal abscesses typically complain of dull perianal
discomfort and pruritus. Their perianal pain often is exacerbated by movement
and increased perineal pressure from sitting or defecation. Physical
examination demonstrates a small, erythematous, well-defined, fluctuant,
subcutaneous mass near the anal orifice.

Patients with ischiorectal abscesses often present with systemic fevers,
chills, and severe perirectal pain and fullness consistent with the more
advanced nature of this process. External signs are minimal and may include
erythema, induration, or fluctuance. On digital rectal examination (DRE), a
fluctuant indurated mass may be encountered. Optimal physical assessment of an
ischiorectal abscess may require anesthesia to alleviate patient discomfort
that would otherwise limit the extent of the examination.

Patients with intersphincteric abscesses present with rectal pain and exhibit
localized tenderness on DRE. Physical examination may fail to identify an
intersphincteric abscess. Though rare, supralevator abscesses present a
similar diagnostic challenge. As a result, clinical suspicion of an
intersphincteric or supralevator abscess may require confirmation by CT scan,
MRI, or anal ultrasonography. The latter is limited to confirming the presence
of an intersphincteric abscess.

----------------------------------------------------------------------



>"jrh" <no@xxxxxxxx> wrote in message news:IlBie.41854$fx3.1635@xxxxxxxxxxxxx
>> In article <Pnvhe.213747$cg1.11305@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx>,
>> petesworkshop@xxxxxxxxxxxxxx says...
>>
>> clip
>>
>>> I asked the surgeon how does he know I don't have proctitis
>>> or a massive yeast infection
>>> and he said if I had proctitis I should be bleeding and he
>>> has never seen yeast in the rectum
>>
>> If you are brave, ask your Doctor about this Diagnostic procedure:
>>
>> 1. After a bowel movement wash the colon several times with
>> water.
>> 2. Insert 10ml of 50-95% ethanol into the rectum.
>> (be prepared it will burn like hell)
>> 3. After 3 to 5 minutes expel the alcohol and mucus into a cup.
>> (20-50ml?)
>> 4. Examine the mucus under a 10-50x stereo microscope for
>> any particles and red or amber(fibrinogen?) streaks.
>> 5. Isolate and examine anything found at 100-2000x
>> especially anything amber.
>> 6. Disolve the remaining mucus in 10% NaOH solution.
>> 7. After the mucus has disolved (softly shake for 2-5 minutes?)
>> neutralize the solution and centrifuge.
>> 8. Remove the liquid, stain the remainder (for fungi) and place
>> on a slide.
>> 9. Examine at 500-2000x.
>>
>> jrh
>>
>
>

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