Relation of Interleukin-1 Receptor Antagonist with C-Peptide in Children with Type 1 Diabetes Mellitus

Abstract

Fistula-in- ano is a track, lined by granulation tissue that connects deeply in the anal canal or rectum and superficially on the skin around the anus. The cryptoglandular hypothesis is the most accepted theory in the pathogenesis of the anal fistulae, also there are some other causes e.g. Crohn’s disease, tuberculosis, actinomycosis, foreign body and trauma. The estimated incidence is about 5.6 per 100.000 in women and 12.3 per 100.000 in men. The disease occurs predominantly in the third and fourth decade of life. In the standard classification of anal fistulae, the fistula is classified into two groups; low level and high level fistulae, but the most widely used classification is that of Parks’ in which the anal fistulae are classified into; intersphincteric, trans-sphincteric, supra-sphincteric and extrasphincteric fistulae. Perianal fistulae present with purulent discharge around the anus, bleeding, diarrhea and pruritis, but if the orifice is occluded the pain is present and increases until the discharge erupts. Summary 103 Fistulography can reveal the depth and the branches of the tracks. However, the injection of dye under high pressure carries the risk of sepsis dissemination. With three dimensions endoanal ultrasound, fistula tract is visualized as tube-like hypoechoic lesion, when hydrogen peroxide 3% is introduced into the fistula tract it generates small air bubbles, the ultrasonographic appearance is changed into bright hyperechoic lesion. By comparing the two images, the fistula tract and its extensions could be identified and discriminated from previous scars. Magnetic resonance imaging is accurate in identifying