ABSTRACT
Introducción: Las lesiones escamosas intraepiteliales de alto grado anales (H-ASIL) son consideradas el precursor del carcinoma escamoso anal. Es por esto que distintas Sociedades recomiendan su pesquisa y tratamiento en poblaciones de alto riesgo. El objetivo del trabajo es describir las manifestaciones de H-ASIL en la anoscopía de alta resolución (AAR) en nuestros pacientes. Diseño: Retrospectivo, descriptivo. Pacientes y métodos: Revisión de historias clínicas e imágenes de AAR de pacientes con diagnóstico de H-ASIL entre enero de 2016 y julio de 2017. La evaluación anoscópica incluyó la unión escamocolumnar, el conducto anal distal y el área perianal. Frente al hallazgo de una lesión sospechosa de ASIL, se tomaron biopsias. Resultados: Entre enero de 2016 y julio de 2017 se realizaron 184 AAR. Se biopsiaron 143 lesiones sospechosas de ASIL. Veintiséis de ellas, presentes en 13 pacientes fueron H-ASIL. Once hombres (diez hombres que tienen sexo con hombre (HSH) con infección por VIH). Todas las lesiones eran subclínicas y se encontraron a nivel endoanal; eran en su totalidad acetoblancas. Se buscaron áreas con puntillado y/o mosaico sugestivas de ASIL. El uso de Lugol nos permitió aumentar el grado de sospecha y delimitar las lesiones. Se tomaron biopsias para anatomía patológica bajo visión directa. Conclusiones: Las H-ASIL son consideradas en la actualidad las precursoras del carcinoma escamoso anal; su detección y tratamiento prevendrían su desarrollo. En nuestra casuística, todos los pacientes se encontraban en al menos un grupo de riesgo. Las lesiones fueron subclínicas y requirieron de la anoscopía de alta resolución para su hallazgo, lo que permitió realizar un tratamiento dirigido. Es importante que los profesionales de la salud consideren la pesquisa de H-ASIL en población de riesgo. (AU)
Introduction: The high-grade anal intraepithelial lesions (H-ASIL) are considered the precursor of the anal squamous cell carcinoma. This is why different societies recommend the screening and treatment in high-risk populations. The objective of this paper is to describe H-ASIL manifestations in the high resolution anoscopy (HRA) in our patients. Design: Retrospective, Descriptive Patients and Methods: Review of clinical histories and pictures of HRA of patients with H-ASIL diagnosis between January 2016 and July 2017. The anoscopic evaluation included the squamocolumnar junction, the distal anal duct and the perianal area. In case of the finding of a suspicious lesion of ASIL, biopsies were taken. Results: Between January 2016 and July 2017 184 HRA were performed. 143 ASIL suspicious lesion were biopsied. Twentysix of them, in 13 patients, were H-ASIL. Eleven were men (10 men who have sex with men with HIV infection). All lesions were subclinical and found at endoanal level. The totality of them were acetowhite. Areas with coarse punctation and a mosaic pattern were suggestive of ASIL. The use of lugol´s iodine allows us to increase the grade of suspect and delimit the lesions. Biopsies were taken for pathology under direct vision. Conclusion: The H-ASIL are considered at the present the precursors of the anal squamous carcinoma. Its development could be prevented with de proper detection and treatment of the H-ASIL. In our casuistic, all patients are in at least one risk group. The lesions were subclinical and required of the high resolution anoscopy for their finding, which allows to perform a directed treatment. It is important that health professionals consider the H-ASIL screening in risk population. (AU)
Subject(s)
Humans , Male , Female , Anus Neoplasms/prevention & control , Precancerous Conditions/diagnosis , Carcinoma, Squamous Cell/prevention & control , Proctoscopy/methods , Papanicolaou Test/methods , Squamous Intraepithelial Lesions/diagnosis , Anal Canal/pathology , Precancerous Conditions/therapy , HIV Infections , Mass Screening , Retrospective Studies , Risk Factors , Homosexuality, Male , Papillomavirus Infections , Early Diagnosis , Squamous Intraepithelial Lesions/therapyABSTRACT
Introducción: La hemorroidopexia con sutura mecánica, es una técnica eficaz para los prolapsos hemorroidales grado III y IV. Objetivo: Describir nuestra experiencia con dicho método. Material y métodos: Se realizó un análisis descriptivo, retrospectivo sobre una base de datos cargada en forma prospectiva. Se analizaron pacientes con hemorroides grado III y IV, en quienes se realizó hemorroidopexia con PPH- 03, desde enero del 2010 hasta diciembre de 2017. Se evaluaron las variables demográficas, las complicaciones y el grado de satisfacción. Se realizó seguimiento postoperatorio semanal, a los 15 días, al mes, a los 6 meses y finalmente un control telefónico. Resultados: Se estudiaron 452 pacientes. La edad media fue de 46 años (rango: 20-75), siendo el 63% (n=291) del sexo masculino. El 84% (n=387) presentaban hemorroides grado III. El índice de complicación fue del 25% (n=115) durante el periodo de seguimiento, en el postoperatorio inmediato, 60 (52%) pacientes presentaron un evento considerado como complicación, y 55 (48%) pacientes presentaron complicaciones mediatas y tardías. Las complicaciones más frecuentes fueron: dolor en 37 (8%) de los pacientes, seguida por proctorragía en 18 casos (4%) y trombosis hemorroidal externa en 15 pacientes (3,3%). (AU)
Background: Hemorrhoidopexy with mechanical suture is an effective technique for hemorrhoidal prolapses grade III and IV. Objective: Describe our experience with this method. Material and methods: A descriptive, retrospective analysis was performed on a prospectively loaded database. Patients with grade III and IV hemorrhoids were analyzed, in whom hemorrhoidopexy was performed with PPH-03, from January 2010 to December 2017. Demographic variables, complications and degree of satisfaction were evaluated. Weekly postoperative follow-up was performed at 15 days, at month, at 6 months and finally a telephone control. Results: 452 patients were studied. The average age was 46 years (range,: 20 - 75), being 63% (n = 291) of the male sex. 84% (n = 387) had grade III hemorrhoids. The complication rate was 25% (n = 115) during the follow-up period, in the immediate postoperative period, 60 (52%). The most frequent complications were: pain in 37 (8%) patients, follow-up by proctorrhagia in 18 cases (4%) and hemorrhoidal thrombosis external in 15 patients (3.3%). (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Suture Techniques , Hemorrhoidectomy/methods , Hemorrhoids/surgery , Postoperative Complications , Reoperation , Retrospective Studies , Follow-Up Studies , Rectal Prolapse/surgery , Patient Satisfaction , AftercareSubject(s)
Humans , Inflammatory Bowel Diseases/diagnosis , Colitis, Ulcerative/diagnosis , Crohn Disease/diagnosis , Diagnosis, Differential , Digestive System Surgical Procedures/statistics & numerical data , Colitis, Ulcerative/surgery , Proctocolectomy, Restorative/adverse effects , Colonic Pouches/adverse effectsSubject(s)
Humans , Male , Female , Colorectal Neoplasms/surgery , Colorectal Neoplasms/etiology , Colitis, Ulcerative/surgery , Colitis, Ulcerative/complications , Elective Surgical Procedures/methods , Digestive System Surgical Procedures/methods , Colorectal Neoplasms/epidemiology , Colitis, Ulcerative/epidemiology , Adenoma/surgery , Adenoma/etiology , Incidence , Follow-Up StudiesSubject(s)
Humans , Male , Female , Digestive System Surgical Procedures/methods , Colitis, Ulcerative/surgery , Colitis, Ulcerative/therapy , Elective Surgical Procedures , Reoperation/methods , Gastrointestinal Agents/therapeutic use , Preoperative Care , Colitis, Ulcerative/epidemiology , Morbidity , Mortality , Laparoscopy/methods , Combined Modality Therapy , Emergency Treatment , Megacolon, ToxicSubject(s)
Humans , Anus Diseases/surgery , Anus Diseases/epidemiology , Rectal Diseases/surgery , Rectal Diseases/epidemiology , Crohn Disease/therapy , Crohn Disease/epidemiology , Perineum/pathology , Ostomy , Crohn Disease/diagnosis , Rectal Fistula/surgery , Rectal Fistula/therapy , Rectovaginal Fistula/surgery , Treatment Outcome , Combined Modality Therapy , Abscess/diagnosis , Abscess/therapySubject(s)
Humans , Digestive System Surgical Procedures/methods , Crohn Disease/surgery , Crohn Disease/complications , Elective Surgical Procedures/methods , Intestinal Diseases/surgery , Colorectal Neoplasms/etiology , Crohn Disease/drug therapy , Risk Factors , Treatment Failure , Emergency Treatment , Intestinal Diseases/pathologySubject(s)
Humans , Digestive System Surgical Procedures/methods , Crohn Disease/surgery , Crohn Disease/epidemiology , Intestine, Small/surgery , Intestine, Small/pathology , Postoperative Complications , Recurrence , Digestive System Fistula/surgery , Abdominal Abscess , Intestinal Obstruction/surgerySubject(s)
Humans , Male , Female , Preoperative Care , Crohn Disease/surgery , Crohn Disease/drug therapy , Colorectal Surgery , Postoperative Care , Recurrence , Biological Products/therapeutic use , Risk Factors , Follow-Up Studies , Adrenal Cortex Hormones/therapeutic use , Immunosuppressive Agents/therapeutic useSubject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Inflammatory Bowel Diseases/epidemiology , Colitis, Ulcerative/epidemiology , Crohn Disease/epidemiology , Argentina/epidemiology , Inflammatory Bowel Diseases/diagnosis , Global Health , Incidence , Prevalence , Sex DistributionSubject(s)
Humans , Male , Adult , Anus Neoplasms , Condylomata Acuminata/drug therapy , Condylomata Acuminata/etiology , Condylomata Acuminata/surgery , Electrosurgery/methods , Papillomavirus Infections/complications , Postoperative Care , Precancerous Conditions/etiology , Precancerous Conditions/surgeryABSTRACT
The aim of this report is to describe a novel technical approach to total anorectal reconstruction and show surgical results and functional outcome. The technique is an innovative surgery to restore gastrointestinal perineal continuity after coloproctectomy in patients with familial adenomatous polyposis. We made the internal anal sphincter replacement with demucosated small bowel plication, the external anal sphincter replacement with an artificial bowel sphincter (ABS) and the restitution of intestinal transit with and ileal "S" pouch. After 12 months follow-up the control of gas is irregular, normal continence to solid stool was achieved with only occasional minimal soiling after defecation. The Jorge-Wexner incontinence score is 6 (moderate incontinence). The fecal incontinence quality of life (FIQL) comparing stoma vs. non-stomas, shows a relevant clinical difference, with improvement in all scales. This study has limitations because it is preliminary, observational and with no control group. We conclude that this recent surgical technique requires expertise in pelvic floor surgery and management of fecal incontinence. The surgeon should be able not only to introduce an artificial anal sphincter, but also to make the plication of intestinal muscle layer to create a zone of high pressure in anal canal and the ileal pouch.
Subject(s)
Adenomatous Polyposis Coli/surgery , Proctocolectomy, Restorative/methods , Adult , Humans , Fecal Incontinence , Male , Quality of Life , Recovery of Function , Treatment OutcomeABSTRACT
Antecedentes: La PAF es una enfermedad hereditaria caracterizada por la presencia de cientos de pólipos adenomatosos colorrectales con un riesgo cercano al 100% de cáncer. El establecimiento de Registros organizados ha demostrado ser de utilidad tanto en la prevención como en la detección precoz de CCR en este grupo. Objetivos: Evaluar el impacto de la citación sistemática en la disminución de la incidencia de CCR en individuos con riesgo para PAF. Comparar el estadio tumoral al momento del diagnóstico, la edad y la sobrevida a los 5 y 10 años entre individuos citados (IC) y de consulta espontánea (CE). Pacientes y métodos: Análisis retrospectivo de la base de datos del Registro de Poliposis del Hospital Dr. Carlos Bonorino Udaondo, constituido en 1995. Dividiendo a la población en dos grupos G1: desde 1975 a 1995 y G2: desde 1995 al 2010. Análisis del número de pacientes con cáncer al momento del diagnostico en los IC y CE en ambos periodos. En aquellos que presentaban adenocarcinoma se analizo la edad de aparición, el estadio tumoral y la sobrevida a los 5 y 10 años. Resultados: Hasta 1995 habia registrados 137 pacientes con PAF; IC 45 de ellos 20% (9) presentaban cáncer al momento del diagnóstico y de los CE el 57%. Desde 1995 a la fecha hay 1804 individuos registrados, 458 con PAF (308 familias). IC 418 detectándose PAF con CCR en 11 (2.6%) y 211 fueron CE encontrando PAF con CCR en 99 (46,9%). En el grupo de IC con CCR el 75% de ellos presentaban estadios tumorales tempranas (El 58.3%, EII 6.7%), en los CE solo el 57,8% fueron estadios tempranas. Conclusiones: Desde que se estableció el Registro y se efectuó una citación sistemática de familiares, la frecuencia de CCR ha disminuido considerablemente entre IC (2.8% vs 20%) con diferencias estadísticamente significativas. El Registro además permitió efectuar un diagnostico precoz de enfermedad en los IC con una disminución de los porcentaje de estadios tardios.
Background: Familial adenomatons polyposis (FAP) is an autosomal dominant inherited disease characterized by hundreds of adenomatous polyps in the large intestine. Nearly 100% affected untreated will have colorectal cancer. The establishment of a Poliposis Registry has demonstrated decrease considerably CCR in FAP. Objetives: The aim of the present study was to evaluate changes in the incidence all CRC, before and after the establishment of the registry. Evaluate tumoral staging, aged and survival rate at 5 and 10 years in call-up patient (CP) and probans (P) with CCR. Patients and methods: A retrospective analysis of Hospital Udaondo Registry database was done. The Registry was established in 1995. The patíents were divided in two groups. G1: since 1975 until 1995 and G2 between 1995 and 2010. Results: At 1995 The Hospital Udaondo Registry included 137 patients with FAP; CP 45 - 9 with CCR (20%) and P with CCR 57% at the diagnosis moment. Since 1995 until 2010 has been included 1804 persons, 458 with FAP. Call-up Patients 418. 11 with PAF and CCR (2.8%) and 211 probans. 99 with CCR (46.9%). 75% of the CP with CCR had early stage (El 58.3%. EII 16.7%) while in the P only 57,8% were early stage. Conclusions: Since the establishment of the registry, the frequency of CRC has decreased considerably (2.8% vs 20%).
Subject(s)
Humans , Colorectal Neoplasms/etiology , Colorectal Neoplasms/prevention & control , Adenomatous Polyposis Coli/diagnosis , Argentina , Early Diagnosis , Hospitals, State , Adenomatous Polyposis Coli/complications , Adenomatous Polyposis Coli/epidemiology , Retrospective StudiesABSTRACT
La poliposis adenomatosa familiar (PAF) es responsable de menos de 1 por ciento de todos los cánceres colorrectales pero resulta ser el mejor modelo de prevención debido a que la detección precoz de la enfermedad y su tratamiento (colectomía o coloproctectomía) abortan la secuencia adenoma carcinoma. El riesgo de cáncer colorrectal (CCR) en este grupo es del 100 por ciento siendo la edad media de presentación temprana (30 años) por lo cual la pesquisa mediante colonoscopías comienza a los 10-12 años continuándose en forma anual o bienal. En este tipo de enfermedades la confección de un árbol familiar exacto es indispensable para evaluar el grado de afectación familiar. Todos los familiares de primer grado de un paciente afectado deberán estudiarse independientemente de su edad. Se presentan dos casos de familias con PAF clásica diagnosticada en individuos jóvenes (< 40 años) en los cuales sus madres mayores de 60 oligosintomáticas eran las portadoras del gen defectuoso, los cuales han resultado en el refuerzo de las conductas indicadas.
Familial Adenomatous Polyposis (FAP) is responsible of less than 1 per cent of all colorectal cancers. However, it represents the best setting to apply prevention strategies such as early detection of the disease and subsequent application of surgical treatment (colectomy or proctocolectomy). As a consequence, the initiation of the adenoma-carcinoma sequence is stopped. The risk of colorectal cancer (CRC) occurence in this group is 100 per cent, being the mean age of presentation 30. Surveillance with colonoscopies starts at 10-12. Since then, a colonoscopy must be done every 1-2 years. In FAP, building a family tree is important to evaluate the extention and familiar involvement of the disease. Every first degree relative of a given patient should undergo a colonoscopy regerdless of their age. We present two cases of families with clasic FAP diagnosed in young individuals (< 40 years), in which their oligosymptomatic mothers (>60 years) were carriers of the malfunctioning gene. Surveillance and diagnostic strategies were triggered by these cases.