Resistencia antibiótica y aspectos clínicos de Neisseria gonorrhoeae anorrectal en un hospital de CABA, Argentina / Antimicrobial resistance and clinical aspects in anorectal Neisseria gonorrhoeae in a hospital in CABA, Argentina

La infección por Neisseria gonorrhoeae (NG) es considerada de alta prioridad en salud pública, por su capacidad para desarrollar resistencia a la mayoría de los antibióticos empleados para tratarla. La presentación anorrectal suele ser asintomática y frecuente en hombres que tienen sexo con hombres (HSH). En Argentina, se recomienda terapia antibiótica dual (ceftriaxona+azitromicina/doxiciclina) como primera línea empírica. Este estudio observacional y retrospectivo se realizó para evaluar el porcentaje de positividad de NG anorrectal, el perfil de sensibilidad a penicilina, tetraciclina, ciprofloxacina, ceftriaxona, cefixima y azitromicina, así como los aspectos clínicos-epidemiológicos de los pacientes atendidos entre 20/10/2015 y 20/03/2020 en consultorios coloproctológicos de un hospital público. Se detectaron 55/436 hisopados rectales positivos para NG (13%). El 95% era HSH y 71%, VIH+. En 18/55 NG fue la única infección. Las co-infecciones más frecuentes: HPV (38%) y C. trachomatis (35%). La sensibilidad a cefalosporinas de espectro extendido (CEE) y a azitromicina fueron 100% y 98%, respectivamente. Se observó la emergencia local de los primeros cinco aislamientos de NG anorrectal con sensibilidad reducida (SR) a CEE, el primer aislamiento con categoría no-sensible a azitromicina y otro con SR a azitromicina concomitantemente con SR a CEE. Aunque el uso de terapia empírica dual sigue siendo adecuado para nuestra institución, se observó la emergencia de aislamientos con SR y NS a las drogas de primera línea, evidenciando la importancia de la vigilancia epidemiológica a nivel local para definir los tratamientos empíricos.

Neisseria gonorrhoeae (NG) infection is considered a high public health priority because of its ability to develop resistance to most of the antibiotics used to treat it.The anorectal presentation is generally asymptomatic and frequent in men who have sex with men (MSM). In Argentina, dual therapy (ceftriaxone+azithromycin/doxycycline) is recommended as first line empiric therapy.This observational and retrospective study was conducted to evaluate the percentage of anorectal NG positivity, the susceptibility profile to penicillin, tetracycline, ciprofloxacin, ceftriaxone, cefixime and azithromycin, as well as the clinical-epidemiological aspects of patients attended between 20/10/2015 and 20/03/2020 in coloproctology of a public hospital.We detected 55/436 positive rectal swabs for NG (13%). 95% were MSM and 71% were PLHIV. In 18/55 NG was the only infection. The most frequent co-infections: HPV (38%) and C. trachomatis (35%).Susceptibility to extended-spectrum cephalosporins (ESCs) and azithromycin was 100% and 98%, respectively. Local emergence of the first five anorectal NG isolates with decreased susceptibility (DS) to ESCs, the first isolate with nonsusceptible category to azithromycin and another with DS to azithromycin concomitantly with DS to ESCs were observed.Although the use of dual empirical therapy continues to be adequate for our institution, the emergence of isolates with DS and NS to first-line drugs was observed, evidencing the importance of epidemiological surveillance at the local level to define empirical treatments

Viruela símica en un paciente con vih: reporte de caso / Monkeypox in a patient with HIV: case report

RESUMEN La viruela símica es una enfermedad zoonótica endémica en algunas zonas de África; desde mayo del 2022 se confirmaron múltiples reportes de viruela símica (VS) en países no endémicos. Se presenta el caso de un paciente con antecedente de VIH con exantemas en diversas regiones del cuerpo, con mayor concentración en la región glútea, asociado a adenopatías cervicales y proctitis infecciosa. Se procedió a la toma de la muestra de las lesiones dermatológicas para el estudio molecular de reacción en cadena de la polimerasa en tiempo real (RT-PCR), que confirmó el diagnóstico de VS. La infección por Treponema pallidum y Neisseria gonorrhoeae se identificó mediante serología y cultivo de secreción anal, respectivamente. Se aplicó tratamiento con antibióticos específicos para gonorrea y sífilis, y la VS respondió favorablemente a la terapia sintomática e inmunomoduladora.

ABSTRACT Monkeypox (Mpox) is a zoonotic disease, endemic in some areas of Africa. But since May 2022, multiple cases of Mpox have been reported in non-endemic countries. We present the case of a patient with a history of HIV, as well as rash in several areas of the body, mostly in the gluteal region, associated with cervical lymphadenopathy and infectious proctitis. Diagnosis was confirmed by real-time polymerase chain reaction (RT-PCR) of skin lesion samples. Treponema pallidum and Neisseria gonorrhoeae infection was confirmed by serology and rectal discharge culture, respectively. The patient received antibiotics specific for gonorrhea and syphilis and his condition improved due to symptomatic and immunomodulatory therapy.

Efficacy of argon plasma coagulation for hemorrhagic chronic radiation proctitis / 肿瘤研究与临床

Objective:To investigate the efficacy and safety of argon plasma coagulation (APC) in the treatment of patients with hemorrhagic chronic radiation proctitis (HCRP).Methods:The clinical data of 36 HCRP patients who received APC treatment in Shanxi Province Cancer Hospital between January 2017 and June 2021 were retrospectively analyzed. The severity of HCRP was assessed by using the Zinicola endoscopic score and the Vienna proctoscopy score. The elimination of rectal bleeding or occasional bloody stools that did not require further treatment within 6 months of the last APC treatment was considered to be the therapy success.Results:The median follow-up time was 1.63 years (0.85-2.68 years). There were 20 (55.6%) patients with severe HCRP according to the Zinicola endoscopic score. After APC treatment, 32 patients with HCRP obtained adequate rectal hemostasis, whereas 4 patients with severe HCRP still experienced rectal bleeding symptoms after APC treatment for several times. All patients received APC treatment for (2.7±1.0) times in total. The endoscopic scores of HCRP patients before and after APC treatment were (3.6±0.8) scores, (1.4± 1.1) scores, respectively; Vienna proctoscopy scores were (3.8±0.8) scores, (1.2±1.1) scores, respectively; and the differences were statistically significant ( t values were 22.37, 18.96; all P < 0.001). The hemoglobin levels of HCRP patients before and after APC treatment were (85±15) g/L, (100±17) g/L, respectively, and the difference was statistically significant ( t = 17.86, P < 0.001). Serious side effects including strictures, perforations, or fistulas and other severe complications related to APC therapy were not found. Conclusions:APC may be an effective and safe treatment option for patients with HCRP.

Argon plasma coagulation in radiation-induced proctitis

Abstract Background Argon plasma coagulation (APC) is a non-tactile ablative therapy that helps to stop rectal bleeding in patients who have developed actinic proctitis after exposure to radiotherapy. This approach seems to be more effective than medications or surgical procedures. Objective To review the literature to verify the effectiveness of APC in the treatment of patients with actinic proctitis induced by radiation therapies. Methods A systematic search was conducted on the following databases: MEDLINE/PubMed, LILACS, SCIELO, and the Cochrane Central Register of Controlled Trials. We identified 81 studies, and 5 of them fulfilled the inclusion criteria. Results In the articles included, a total of 236 patients were evaluated. Most of them were men (67.7%) with a mean age of 66.6 years. Prostate cancer was the main cause of actinic proctitis (67.3%), and control of the bleeding was achieved in 83.3% of the cases, after a mean of 1.67 session of APC. Moreover, 66 patients had complications with the treatment, and rectal pain was the most referred. Conclusions Argon plasma coagulation is a well-tolerated and effective treatment to control rectal bleeding in patients who underwent radiotherapy, and the number of sessions varies from 1 to 2, according to the case. (AU)

Argón plasma: respuesta terapéutica y calidad de vida en pacientes con proctitis actínica crónica hemorrágica / Impact of exclusive breastfeeding withdrawal on the health of babies

Introducción: La proctitis actínica crónica hemorrágica (PACH) se presenta secundaria a la radioterapia pélvica. La coagulación con argón plasma (APC) es una terapéutica eficaz, segura, de fácil uso y relativo bajo costo. Objetivo: Describir la respuesta terapéutica a corto y largo plazo del APC en pacientes con PACH, así como evaluar la calidad de vida antes y después de la intervención. Material y Métodos: Estudio observacional, prospectivo de serie de casos en 46 pacientes con PACH, atendidos en el Centro Nacional de Cirugía de Mínimo Acceso entre 2017 y 2020. Se emplearon medidas de resumen y comparación de medias (t de Student pareada) para la hemoglobina inicial y final, así como para los puntajes de calidad de vida aplicados antes y después de la intervención. Para determinar el tiempo libre de resangrado se utilizó l Método de Kaplan-Meier. Se estimó una significación menor a 0.05 para un intervalo de confianza de 95 por . Resultados: Se necesitó una media de 3,6 ± 2,394 sesiones de APC. La media de hemoglobina se incrementó 1,9 g/L. La respuesta terapéutica a corto plazo se observó en 100 por ciento de los pacientes y a largo plazo en 91,3 . La media de puntaje para la calidad de vida descendió en 12,065 puntos (p˂ 0,00), La percepción global percibida se incrementó en una media de 7.326 puntos (p˂ 0,00). Conclusiones: El APC tiene buena respuesta terapéutica a corto y largo plazo con pocas sesiones y bajo número de complicaciones, con mejoría de la calidad de vida de los pacientes(AU)

Introduction: Chronic hemorrhagic radiation proctitis (CHRP) appears secondary to pelvic radiotherapy. Argon plasma coagulation (APC) is an effective, safe, easy-to-use, and relatively inexpensive therapy. Objective: To describe the short- and long-term therapeutic response of APC in patients with CHRP, as well as to evaluate the quality of life before and after the intervention. Material and Methods: Observational, prospective case series study of 46 patients with CHRP, treated at the National Center for Minimally Access Surgery between 2017 and 2020. Summary measures and comparison of means (paired Student's t-test) were used for baseline and final hemoglobin, as well as for the quality of life scores applied before and after the intervention. The Kaplan-Meier method was used to determine the recurrence free time. A level of significance less than 0.05 was estimated for a 95 por ciento confidence interval. Results: A mean of 3,6 ± 2,394 APC sessions was required. The mean hemoglobin increased 1,9 g / L. Short-term therapeutic response was observed in 100 % of patients, and long-term in 91,3 por ciento. The mean score for quality of life decreased by 12,065 points (p˂ 0,00). The perceived global perception increased by a mean of 7,326 points (p˂ 0,00). Conclusions: APC has a good therapeutic response in the short and long term with few sessions and a low number of complications, with an improvement in the quality of life of the patients(AU)

Therapeutics in radiation-induced proctopathy: a systematic review

Malignant neoplasms are increasingly prevalent in the daily clinical practice. Up to 61% of patients with pelvic malignancies undergo pelvic radiotherapy in different doses, which may cause intestinal damage, and the rectum is the segment most frequently affected due to its fixed position in the pelvis. Currently, there are several strategies to minimize the effects of radiation on the tissues surrounding the neoplastic site; despite those strategies, radiotherapy can still result in serious damage to organs and structures, and these injuries accompany patients throughout their lives. One of the most common damages resulting from pelvic radiotherapy is acute proctitis.The diagnosis is confirmed by visualizing the rectal mucosa through rigid or flexible rectosigmoidoscopy and colonoscopy. The objective of the present study was to review the forms of radiation-induced proctopathytherapy, and to evaluate the results of each method to propose a standardization for the treatment of this pathology. Despite the prevalence of radiation-induced proctopathy, there is no definitive standardized treatment strategy so far. The first approach can be tried with local agents, such as mesalazine and formalin. For refractory cases, control can usually be achieved with argon plasma coagulation, hyperbaric oxygen, and radiofrequency ablation therapies. Regarding the study of radiation-induced proctopathy, there is a lack of robust studies with large samples and standardized therapies to be compared. There is a lack of double-blinded, randomized controlled studies to determine a definitive standard treatment algorithm. (AU)

Proctitis y enfermedad perianal de causa infecciosa: una mirada más allá de la enfermedad inflamatoria intestinal / Infectious proctitis and perianal disease: a gaze beyond inflammatory bowel disease

Resumen La proctitis infecciosa secundaria a una enfermedad de transmisión sexual ha aumentado en incidencia y deben ser consideradas especial-mente en varones homosexuales o bisexuales con síntomas rectales. Presentamos un paciente con una proctitis y enfermedad perianal por Chlamydia trachomatis que podría haber sido diagnosticado con otra enfermedad ano-rectal como es la enfermedad inflamatoria intestinal, si la historia clínica no hubiese sido considerada. Un alto nivel de sospecha es necesario para evitar un diagnóstico incorrecto, retrasar el tratamiento antimicrobiano y el desarrollo de complicaciones.

Abstract Infectious proctitis by sexually transmitted diseases are increasing in incidence and should be considered in homosexual patients with rectal symptoms. In this case, we show a patient with proctitis and perianal disease caused by Chlamydia trachomatis that could be diagnosed as another anorectal disease such as inflammatory bowel disease if the clinical history is not taken into account. A high level of suspicion is crucial, in order to avoid an incorrect diagnosis, delayed antibiotic therapy and the development of complications.

Características epidemiológicas y manifestaciones clínicas de pacientes con proctitis infecciosa / Epidemiologic characteristics and clinical manifestations in patients with infectious proctitis

Resumen Objetivo: Describir y caracterizar los aspectos epidemiológicos y clínicos de los pacientes con proctitis infecciosa en nuestro hospital. Materiales y Método: Se trata de un estudio de tipo transversal de pacientes con sintomatología perianal y del canal anal, concordante con proctitis, que consultaron en el policlínico de coloproctología entre enero de 2017 y diciembre de 2018, a quienes se les realizó estudio de secreción anal para confirmar infección de transmisión sexual. Resultados: Son 46 pacientes hombres, 26 años promedio de edad, un 6% heterosexuales. Un 65% había consultado previamente (ninguno a un coloproctólogo). El síntoma más frecuente: ano húmedo (97,8%) y el signo: dermitis perianal (100%). De este grupo, 20 nunca se habían realizado estudio de VIH y 50% resultó ser seropositivo. Presentaban infecciones de transmisión sexual más comunes: Gonorrea (43,4%) y sífilis (31,2%) y en un 32% hubo presencia de más de un germen. Discusión: Los resultados sugieren que la proctitis infecciosa es una patología de pacientes jóvenes quienes tienen relaciones sexuales sin protección, más del 50% no utiliza condón. La mayoría de los pacientes presentan consultas previas con médicos no proctólogos. Los gérmenes con mayor frecuencia que provocan proctitis infecciosa: Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum. Conclusión: La presencia de una dermitis perianal sin respuesta a tratamiento habitual, muy severa y/o en pacientes de riesgo, debe hacer sospechar proctitis infecciosa.

Objective: Describe and characterize epidemiological and clinical aspects of patients with infectious proctitis at our hospital. Materials and Method: This is a cross-sectional study of patients with perianal and anal canal symptoms consistent with proctitis, who consulted at the Clinical Hospital of The University of Chile coloproctology outpatient clinic between January 2017 and December 2018, with perianal and anal canal symptoms, consistent with proctitis, and with confirmed sexually transmitted disease by anal secretion study. Results: Total of 46 patients, all male with average age of 26 years old. 6% heterosexuals. 65% had previous medical consults (none with a proctologist). The most common symptom was wet anus (97.8%), and the most common physical finding was perianal dermatitis (100%). 20 patients had never been tested for HIV, and 50% were positive for this disease. The most common sexually transmitted diseases were gonorrhea (43.4%) and syphilis (31.2%). In 32% of the patients, the culture informed more than one pathogen. Discussion: The results suggest that infectious proctitis is a disease of young patients who have unprotected sex. More than 50% do not use a condom. Most patients have prior consults, but none with a proctologist. The most frequent pathogen that causes infectious proctitis: Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum. Conclusion: The presence of severe perianal dermatitis, lack of response to common treatment, and/or in patients with risk factors, infectious proctitis should be suspected.

Evaluation of mesalazine polymeric conjugate in the treatment of actinic proctitis in rats

ABSTRACT Purpose: The present study aimed at testing a new formulation of mesalazine linked to chondroitin sulfate and its components alone in the treatment of actinic proctitis in rats. Methods: Forty-seven female Wistar rats were submitted to pelvic radiation and divided into eight groups: control A, mesalazine A, chondroitin A, and conjugate A, gavage of the according substance two weeks after irradiation and sacrifice three weeks after oral treatment; control C, mesalazine C, chondroitin C, and conjugate C, sacrifice six weeks after oral treatment. The rectum was submitted to histological characterization for each of the findings: inflammatory infiltrate, epithelial degeneration, mucosal necrosis, and fibrosis. Results: The inflammatory infiltrate was more intense in chondroitin A, mesalazine A, and conjugate C. The collagen deposition was less intense in chondroitin A, and mesalazine A, and more intense in control C. Conclusions: Mesalazine and chondroitin alone were efficacious in inducing a delayed inflammatory response, hence reducing the late fibrosis. The conjugate was able to induce an ever more delayed inflammatory response.

Chronic radiation-induced rectal injury after adjuvant radiotherapy for pelvic malignant tumors: report based on a phase 3 randomized clinical trial / 中华胃肠外科杂志

Objective: Radiotherapy is one of the standard treatments for pelvic malignant tumors. However, researches associated with intestinal radiation injury and the quality of life (QoL) of patients receiving radiotherapy were lacking in the past. This study aims to analyze the occurrence of radiation-induced rectal injury after adjuvant radiotherapy for pelvic malignant tumors and call for more attention on this issne. Methods: A retrospectively observational study was conducted. Case data of cervical cancer patients from the database of STARS phase 3 randomized clinical trial (NCT00806117) in Sun Yat-sen University Cancer Center were analyzed. A total of 848 cervical cancer patients who received adjuvant radiation following hysterectomy and pelvic lymphadenectomy in Sun Yat-sen University Cancer Center from February 2008 to August 2015 were recruited. The pelvic radiation dosage was 1.8 Gy/day or 2.0 Gy/day, five times every week, and the total dosage was 40-50 Gy. Among 848 patients, 563 patients received radiation six weeks after surgery, of whom 282 received adjuvant radiation alone and 281 received concurrent chemoradiotherapy (weekly cisplatin); other 285 patients received sequential chemoradiotherapy (paclitaxel and cisplatin). Acute adverse events, chronic radiation damage of rectum, and QoL were collected and analyed. The digestive tract symptoms and QoL were evaluated based on EORTC QLQ-C30 questionnaires at one week after surgery (M0), during adjuvant therapy period (M1), and at 12 months and 24 months after the completion of treatments (M12 and M24), respectively. Higher scores in the functional catalog and overall quality of life indicated better quality of life, while higher scores in the symptom catalog indicated severe symptoms and worse QoL. Chronic radiation rectal injury was defined as digestive symptoms that were not improved within three months after radiotherapy. Grading standard of acute adverse events and chronic radiation rectal injury was according to the gastrointestinal part of National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0 (NCI-CTCAE Version 4.0). Results: The mean total radiation dosage of 848 patients was (47.8±4.6) Gy. During adjuvant therapy, the common symptoms of acute intestinal dysfunction were nausea (46.0%, 390/848), vomiting (33.8%, 287/848), constipation (16.3%, 138/848) and abdominal pain (10.3%, 87/848). At M12 and M24, the number of 0 QLQ-C30 questionnaires collected was 346 and 250, respectively. QLQ-C30 questionnaires showed that the scores of nausea or vomiting, appetite decrease, diarrhea, constipation, etc. were improved obviously at M12 or M24 compared with those at M0 or during M1 (all P<0.05). As the extension of the follow-up time, the score of the overall QoL of patients gradually increased [M0: 59.7 (0.0-100.0); M1: 63.1 (0.0-100.0); M12: 75.2 (0.0-100.0); M24: 94.1 (20.0-120.0); H=253.800, P<0.001]. Twelve months after the completion of treatments, the incidence of chronic radiation rectal injury was 9.8% (34/346), mainly presenting as abdominal pain, constipation, stool blood, diarrhea, mostly at level 1 to 2 toxicity (33/34, 97.1%). One patient (0.3%) developed frequent diarrhea (>8 times/d), which was level 3 toxicity. Twenty-four months after all treatments, the incidence of chronic radiation rectal injury was 9.6% (24/250), which was not decreased significantly compared to that in the previous period (χ(2)=0.008, P=0.927). The symotoms of one patient with level 3 toxicity was not relieved. Conclusions: The common symptoms of patients with pelvic maligant tumors during postoperative adjuvant radiotherapy include nausea, vomiting, constipation, abdominal pain and diarrhea. These symptoms are alleviated obviously at 12 and 24 months after adjuvant radiotherapy, and the QoL is significantly improved. However, a few patients may develop chronic radiation rectal injury which is not improved for years or even decades, and deserves attention in clinical practice.

El Linfogranuloma venéreo rectal: presentación clínica emergente / Rectal lymphogranuloma venereum: an emergent clinical presentation

El linfogranuloma venéreo (LGV) es una enfermedad de transmisión sexual (ETS) poco frecuente causada por los serotipos L1, L2 y L3 de Chlamydia trachomatis.Desde hace más de una década se produjo un aumento de la incidencia de proctitis por LGV casi exclusivamente en hombres que tienen sexo con hombres con prácticas sexuales de riesgo para ETS.Se presentan cuatro casos con LGV rectal

Lymphogranuloma venereum is a rare sexually transmitted infection (STI) caused by serotypes L1, L2 and L3 of Chlamydia trachomatis.For over a decade, there has been a considerable increase in the incidence of LGV proctitis in almost exclusively men who have sex with men with STI risk behaviors.Four cases of rectal LGV are reported

Proctitis infecciosa transmitida sexualmente: reto diagnóstico y recomendaciones de tratamiento / Sexually transmitted infectious proctitis: diagnostic challenge and treatment recommendations

RESUMEN La proctitis infecciosa (PI) transmitida sexualmente es un proceso inflamatorio del recto secundario a la infección por gérmenes de transmisión sexual. Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum y el virus herpes simple (VHS) son las causas más comunes. Es más prevalente en hombres que tienen sexo con hombres (HSH) y en pacientes con infección por el virus de inmunodeficiencia humana (VIH), sin embargo, también se diagnostica en heterosexuales por cambios en el comportamiento sexual. La urgencia fecal, el exudado purulento o sanguinolento, la proctalgia y el tenesmo son las manifestaciones clínicas más frecuentes. La historia clínica detallada y un alto índice de sospecha son importantes para establecer el diagnóstico de esta patología; apoyados en los estudios endoscópicos, histológicos, serológicos y microbiológicos. Se recomienda el tratamiento empírico, con antibióticos o antivirales, según la sospecha clínica y siempre deben descartarse otras infecciones de transmisión sexual (ITSs).

ABSTRACT Sexually transmitted infectious proctitis is an inflammatory process of the rectum secondary to infection by sexually transmitted germs. Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex virus (HSV) are the most frequently pathogens. Infectious proctitis is more prevalent in men who have sex with men (MSM) and in patients with human immunodeficiency virus (HIV) infection, however, it is also diagnosed in heterosexuals by changes in sexual behavior. Fecal urgency, purulent or bloody exudate, proctalgia, and tenesmus are the most common clinical manifestations. Detailed clinical history and a high index of suspicion are important to establish the diagnosis of this pathology; supported by endoscopic, histological, serological, and microbiological studies. Empirical treatment with antibiotics or antivirals is recommended, depending on clinical suspicion, and other sexually transmitted infections (STIs) should always be ruled out.

A Case Report of Radiation Proctitis Treated with Shiunko Enema / 日本東洋医学雑誌

We report a case of a 57-year-old woman with radiation proctitis (RP) treated by shiunko (SK) enema with promising outcomes. The patient underwent interstitial brachytherapy for anterior vaginal vault recurrence of uterine cancer. Nine months after the treatment, she had anal pain and was diagnosed with RP by clinical course and colonoscopy. The rectal ulcer was so severe that a surgeon proposed permanent stoma formation as one option, given eventual risk of rectovaginal fistula. The patient rejected stoma formation and opted for Kampo medicine. Though she took keishibukuryogankayokuinin for blood stasis at first, her anal pain and rectal bleeding gradually worsened. Thereafter, she mainly used SK enema, kyukikyogaito and magnesium oxide. Anal pain and rectal bleeding decreased after applying SK to the rectal wall per rectum. Magnetic resonance imaging (MRI) and colonoscopy findings of the rectal ulcer also improved. SK effectively reduced anal pain and rectal bleeding as well as stimulated tissue repair in our patient, and therefore SK is worth considering in the treatment of RP.

Preliminary clinical analysis of radiation proctitis treated with argon plasma coagulation combined with submucosal injection / 中华放射肿瘤学杂志

Objective To preliminarily evaluate the clinical efficacy of endoscopic argon plasma coagulation (APC) combined with sub-mucosal injection of norepinephrine saline in the treatment of radiation proctitis (RP),especially for refractory RP.Methods Clinical data of 22 RP patients were retrospectively analyzed.The severity of RP was evaluated by a modified endoscopy scoring system (A) or Sherman's classification (B).The criteria of successful treatment are the improvement of clinical symptoms or the cessation of bleeding (or only occasional traces of blood on the stools that do not need further treatment).Results All 22 patients were successfully treated.Among them,18 patients (82％) had no bleeding.According to the classification of A,15 patients (68％) had mild proctitis and 7(32％) experienced severe proctitis.Based on B classification,9 patients (41％) were categorized as mild proctitis and 13(59％) as severe proctitis.Using the classification of A,the number of treatment sessions was significantly correlated with the endoscopic grade (or endoscopic total score) (Spearman's r=0.86,P＜0.001).Conclusions Preliminary evidence demonstrates that endoscopic APC combined with sub-mucosal injection of norepinephrine saline is not only effective for mild and moderate RP,but also maintains long-term efficacy for refractory RP.Modified endoscopy scoring system (A) assessment is more suitable for clinical application compared with B assessment.

Preliminary clinical analysis of radiation proctitis treated with argon plasma coagulation combined with submucosal injection / 中华放射肿瘤学杂志

Objective@#To preliminarily evaluate the clinical efficacy of endoscopic argon plasma coagulation (APC) combined with sub-mucosal injection of norepinephrine saline in the treatment of radiation proctitis (RP), especially for refractory RP.@*Methods@#Clinical data of 22 RP patients were retrospectively analyzed. The severity of RP was evaluated by a modified endoscopy scoring system (A) or Sherman′s classification (B). The criteria of successful treatment are the improvement of clinical symptoms or the cessation of bleeding (or only occasional traces of blood on the stools that do not need further treatment).@*Results@#All 22 patients were successfully treated. Among them, 18 patients (82%) had no bleeding. According to the classification of A, 15 patients (68%) had mild proctitis and 7(32%) experienced severe proctitis. Based on B classification, 9 patients (41%) were categorized as mild proctitis and 13(59%) as severe proctitis. Using the classification of A, the number of treatment sessions was significantly correlated with the endoscopic grade (or endoscopic total score)(Spearman’s r=0.86, P<0.001).@*Conclusions@#Preliminary evidence demonstrates that endoscopic APC combined with sub-mucosal injection of norepinephrine saline is not only effective for mild and moderate RP, but also maintains long-term efficacy for refractory RP. Modified endoscopy scoring system (A) assessment is more suitable for clinical application compared with B assessment.

Changrui enema inhibits inflammation-induced angiogenesis in acute radiation proctitis by regulating NF-κB and VEGF

Abstract Purpose Changrui enema, a traditional Chinese medicine prescription, is used as a supplementary treatment for acute radiation proctitis (ARP). Herein we explored the inhibition effects of Changrui enema on NF-κB and VEGF in ARP mice. Methods A total of 120 C57BL/6 mice were divided randomly into normal mice group, ARP mice group, western medicine enema group (dexamethasone combined with gentamicin), and Changrui enema group. ARP mice were established by pelvic local irradiation. The expression of IL-1β, NF-κB, VEGF, AQP1, AQP3, p-ERK1/2 and p-JNK was determined by immunohistochemistry or western blot. Results The study firstly found that Changrui enema alleviated ARP mice. The expression of IL-1β, NF-κB, VEGF, AQP1 and p-ERK1/2 was increased in ARP mice, and was reserved by Changrui enema. However, the expression of AQP3 and p-JNK was decreased in ARP mice, and was up-regulated by Changrui enema. Conclusions Changrui enema is an effective treatment with fewer side effects for ARP. The mechanism of Changrui enema may be related to the inhibition of inflammation-induced angiogenesis. Changrui enema inhibits IL-1β and NF-κB expression as well as VEGF expression. Interestingly, AQP1 promotes angiogenesis, while AQP3 inhibits inflammation. Changrui enema probably inhibits AQP1 expression by down-regulating p-ERK1/2, and improves AQP3 expression by up-regulating p-JNK.

Manifestaciones coloproctológicas de las infecciones de transmisión sexual ocasionadas por Chlamydia Trachomatis, Neisseria Gonorrhoeae y Treponema Pallidum. Presentación casuística / Coloproctological manifestations of sexually transmitted infections caused by Chlamydia Trachomatis, Neisseria Gonorrhoeae and Treponema Pallidum. Case presentation

Introducción: Las infecciones transmisibles sexualmente (ITS) con afectación anorrectal constituyen un desafío pues las manifestaciones producidas por Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) y Treponema pallidum (TP) son similares. Objetivo: Evaluar si las manifestaciones anorrectales debidas a CT, NG y TP asociadas al examen proctológico permiten diagnóstico certero, sin estudios complementarios. Pacientes y método: Estudio retrospectivo. Revisión de registros de pacientes atendidos en consultorio coloproctológico. Periodo: 01/08/2015-01/07/2016. Se incluyeron pacientes con diagnóstico de ITS anorrectal, excepto aquellos con HPV únicamente. A todos se les pesquisaron ITS mediante hisopado anal para CT por inmunofluorescencia y para estudio directo y cultivo de NG, VDRL para TP y además HIV. Variables: sexo, edad, HIV, sexo anal, uso de preservativo, motivo de consulta y resultado de estudios efectuados. Resultados: Treinta y cuatro pacientes (32 hombres). Edad mediana 31,5 años (rango: 19-65). Veinticinco pacientes HIV + (73,5%). Veintinueve pacientes (28 hombres) mantenían sexo anal. 91% no usaba preservativo adecuadamente. 65% tuvo una única infección (ITS pura). Se diagnosticaron 14 sífilis (8 puras), 14 clamidiasis (7 puras) y 11 gonococcias (7 puras). Co-infección entre ellas: 9% y con HPV: 26%. La úlcera fue la manifestación en 7/8 casos de sífilis puras (todas dolorosas, excepto una). El resto presentó síntomas variados (condilomas virales atípicos, secreción purulenta y proctorragia). Más del 50% de las gonococias puras (4/7) se manifestó con úlcera, sin embargo, el dolor estuvo presente siempre (8/8) y en tres se asoció secreción purulenta. En cambio, la mitad de los pacientes con clamidiasis puras, se manifestó con proctorragia causada por un tumor rectal/sigmoideo inflamatorio, clínicamente indistinguible de neoplasia maligna. Todos las sífilis y gonococias tuvieron correlato con las pruebas diagnósticas, no así las clamidiasis cuyo diagnóstico no pudo confirmarse en tres casos (37,5%), que respondieron al tratamiento empírico. Conclusión: NG y TP anorrectal provocaron mayormente síntomas similares a los de etiología no venérea y se requirió del laboratorio para el diagnóstico etiológico. La presencia de tumor con biopsia negativa para neoplasia maligna en pacientes de riesgo para ITS obliga a descartar clamidiasis. (AU)

Introduction: Sexually transmitted infections (STIs) are a challenge in medical consultation. The clinical manifestations of infection by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Treponema pallidum ( TP) share symptoms at anorectal level. This implies the need for a high index of suspicion for diagnosis, which is based on history, physical examination and laboratory tests that not always are accurate or available . Purpose: Assess whether clinical signs of anorectal infections by CT, NG and TP associated with proctologic exams, lead to an accurate etiologic diagnosis without the help of specific laboratory studies. Patients and methods: Observational, retrospective study, based on a review of records of patients treated at the outpatient clinic of the Hospital Fernandez (City of Buenos Aires) department of coloproctology, in the period between August 2015 and July 2016. Patients who underwent STI diagnosis were all considered, but to those whose only diagnosis was infection by human papilloma virus (HPV) were excluded from the analysis. All patients were tested after the three etiologies of STI (anal swab for CT study by immunofluorescence, swabbing for direct study, and cultivation of NG and TP VDRL) and HIV. Variables analyzed: sex, age, presence of HIV infection, practice of receptive anal sex, proper use of condoms, signs and symptoms that prompted the consultation, and results of diagnostic tests. Results: 34 patients (32 men) were included. Median age 31.5 years (range: 19-65, interquartile range: 26-37). Twenty-five patients (73.5%) were HIV+. Twenty-nine patients (28 men) remained receptive anal sex. 91% did not use condoms properly. 65% of infections were pure, without other STI asociada-. 14 cases of syphilis (8 pure), 14 Chlamydia (7 pure) and 11 gonococcias (7puras), including co-infection in 9% of cases, no evidence of a more frequent another co-infection diagnosed. Co-infection with HPV was detected in 9 (26%) cases. The ulcer was the sign in 7/8 cases of pure syphilis (all painful, except one). The rest is expressed by a variety of symptoms (atypical viral warts, purulent and bloody diarrhea). Similarly, just over 50% (4/7) of pure gonococcias demonstrated ulcer, but the pain was always present (8/8 of pure gonococcias) and three associated with purulent discharge. Instead of the ten patients with pure chlamydia, 50% manifested with bloody diarrhea caused by a rectal tumor / inflammatory sigmoid, clinically indistinguishable from malignancy. All cases of syphilis and gonococcal were correlated with diagnostic tests; not those whose diagnosis of chlamydial infection (confirmed in eight and was negative in three, 37.5%) who responded to empiric treatment indicated by the clinical suspicion. Conclusion: While this is a small series, it shows that the NG and TP in the anorectal location mostly caused symptoms similar to those of non-venereal ethology most of the times, and laboratory assistance for etiologic diagnosis was required. The presence of tumor with negative biopsy for malignancy in patients at risk for STIs, leads chlamydia to be ruled out. (AU)

Proctitis crónica hemorrágica por radioterapia en el Instituto Nacional de Enfermedades Neoplásicas del Perú, 2011-2013 / Radiotherapy associated chronic hemorrhagic proctitis at the National Institute of Neoplastic Diseases of Peru, 2011-2013

Objetivo: Estudiar las características clínicas y endoscópicas de la proctitis crónica hemorrágica por radioterapia en el Instituto Nacional de Enfermedades Neoplásicas del Perú. Materiales y métodos: Estudio descriptivo, retrospectivo y longitudinal, con una población de 588 pacientes con esta patología, en el periodo 2011-2013, de donde se seleccionaron 114 pacientes por muestreo probabilístico aleatorizado. Se usó la estadística descriptiva e inferencial para el análisis de las variables cualitativas y cuantitativas. Resultados: La investigación encontró como principales resultados, un periodo de latencia de 439,96 días; la severidad de rectorragia clínica fue grado II y III en el 86,84%, la hemoglobina media fue de 11,63 gr/dl, los hallazgos endoscópicos fueron severidad moderada en el 58,77%, extensión solo rectal en el 92,11%, friabilidad leve del 43,86%, compromiso menor del 33% de la superficie rectal en el 71,93% y una longitud media de 7,28 cm. Los hallazgos inflamatorios fueron de cicatrices en el 0,88%, erosiones del 0,88%, de úlceras del 7%, de fístula del 0,88% y del 3,51% de estenosis rectales, el tratamiento de argón plasma coagulación (APC) único o combinado se ofreció en el 96% de los casos. Conclusiones: La proctitis crónica hemorrágica por radioterapia fue una complicación importante de la radioterapia pélvica, con hallazgos clínicos y endoscópicos característicos.

Objective: To study the clinical and endoscopic features of chronic hemorrhagic proctitis by radiotherapy in the National Institute of Neoplastic Diseases of Peru. Materials and methods: The study was descriptive, retrospective and longitudinal, with a population of 588 patients with this pathology, in the period 2011-2013, from which 114 patients were selected by randomized probabilistic sampling. Descriptive and inferential statistics were used for the analysis of qualitative and quantitative variables. Results: The main results were a latency period of 439.96 days; the severity of clinical rectal bleeding was grade 2 and 3 in 86.84%, the mean hemoglobin in chronic hemorrhagic proctitis by radiotherapy was 11.63 g / dl, the endoscopic findings were moderate severity in 58.77%, extension rectal only in 92.11%, slight friability of 43.86%, compromise less than 33% of the rectal surface in 71.93% and an average length of 7.28 cm. The inflammatory findings were 0.88% scars, erosions of 0.88%, ulcers of 7%, fistula of 0.88% and 3.51% of rectal stenosis, single or combined argon plasma coagulation (APC) treatment was offered in 96% of cases. Conclusion: Chronic hemorrhagic proctitis is an important complication of pelvic radiotherapy, with characteristic clinical and endoscopic findings.

Proctitis infecciosa por Chlamydia Trachomatis / Infectious proctitis by Chlamydia Trachomatis

Introducción: Las infecciones transmisibles sexualmente (ITS) son motivo de consulta frecuente, encontrándose Chlamydia trachomatis (CT) entre las prevalentes. Este germen provoca proctitis de diversa gravedad según el biovar involucrado. Los casos más floridos suelen ser ocasionados por el biovar LGV, responsable de la entidad linfogranuloma venéreo. Se desconocen la prevalencia de CT como causa de proctitis en Argentina y los biovares implicados. Con el objetivo de estudiar estas variables, se diseñó un protocolo para detectar y genotipificar CT en pacientes con proctitis infecciosa. Pacientes y métodos: Se incluyeron pacientes mayores de 18 años con cuadro de proctitis infecciosa atendidos en un centro público y otro privado. Se excluyeron pacientes con enfermedad inflamatoria intestinal y radioterapia pelviana. El estudio fue aprobado por un Comité de Ética y los pacientes firmaron un consentimiento informado. En las muestras de hisopado anal se realizó detección y tipificación molecular de CT. Resultados: Entre 31de agosto de 2017 y 31 de mayo de 2018, se incluyeron 56 pacientes (1 mujer, 53 hombres, 2 mujeres trans), 79% HIV+. En 29 casos (52%) se detectó CT. Todos eran hombres que tienen sexo con hombres (HSH) y refirieron practicar sexo anal u oral receptivo no protegido. La mediana de edad de este subgrupo fue de 31 años; 83% HIV+ en tratamiento antirretroviral y mediana de CD4 637 cel/mm3. La coinfección con otras ITS fue del 41% (siendo las más frecuentes HPV, gonococia y sífilis). Los motivos de consulta más frecuentes fueron proctorragia, pujo y tenesmo, proctalgia y secreción. Las manifestaciones clínicas fueron variadas: proctitis, úlcera perianal, tumor endoanal/rectal y absceso/fístula. El 86% de las proctitis correspondió al biovar LGV, siendo 62% moderadas a graves. La mediana de tiempo de evolución hasta el diagnóstico fue 21 días. Los casos más prolongados correspondieron a cuadros clínicos y endoscópicos más graves. La duración del tratamiento se adecuó al biovar involucrado. Todos los pacientes respondieron favorablemente; sin embargo, las dos fístulas perianales requirieron resolución quirúrgica. Conclusiones: Proctitis, úlceras y fístulas son manifestaciones inespecíficas; el hallazgo clínico y endoscópico per se no son suficientes para definir la etiología; sólo una anamnesis minuciosa permite presumir una ITS como agente causal. La tipificación logra definir el biovar, dato fundamental para adecuar el tratamiento, cortar la cadena de transmisión y contar con datos epidemiológicos a nivel local. Como resultado de esta investigación, el Ministerio de Salud de Nación proyectó la emisión de una alerta sobre la presencia de LGV en nuestro medio. Tipo de estudio: Observacional, transversal, analítico, multicéntrico.

Introduction: Sexually transmitted infections (STI) are a frequent reason for consultation, being Chlamydia trachomatis (CT) among the most prevalent ones. It causes proctitis of varying severity depending on the biovar involved. The most severe cases are usually caused by the LGV biovar, responsible for the entity called lymphogranuloma venereum. The prevalence of CT as a cause of proctitis in Argentina and the biovars involved are unknown. In order to study these variables, a protocol was designed to detect and genotype CT in patients with infectious proctitis. Patients and methods: Patients over 18 years old with infectious proctitis were attended in a public and private center. Patients with inflammatory bowel disease and pelvic radiation therapy were excluded. The study was approved by an Ethics Committee and the patients signed an informed consent. The detection and molecular typing of CT was performed in anal swab samples. Results: Between 31-08-2017 and 31-05-2018, 56 patients were included (1 woman, 53 men, 2 trans women), 79% HIV +. In 29 cases (52%) CT was detected. All were MSM and reported to practice unprotected receptive oral or anal sex. The median age of this subgroup was 31 years; 83% HIV + on antiretroviral treatment and median CD4 637 cel / mm3. The coinfection with other STIs was present 41% (the most frequent were HPV, gonococcal and syphilis). The most frequent symptoms were bleeding, tenesmus, proctalgia and secretion. The clinical manifestations were varied: proctitis, perianal ulcer, endoanal / rectal tumor and abscess / anal fistula. 86% of the proctitis corresponded to the LGV biovar, being 62% moderate to severe. The median time of evolution until the diagnosis was 21 days. The most prolonged cases corresponded to more severe clinical and endoscopic symptoms. The duration of the treatment was adapted to the biovar involved. All patients responded favorably; however, the two perianal fistulas required surgical resolution. Conclusions: Proctitis, ulcers and fistulas are nonspecific manifestations; the clinical and endoscopic findings per se are not sufficient to define the etiology; only a meticulous anamnesis allows us to presume an STI as a causative agent. The typification allows to define the biovar, a fundamental data to adapt the treatment, stop chain of transmission and provides local epidemiological data. As a result of this investigation, the Ministry of Health of the Argentina issued an alert about the presence of LGV in our country. Type of study: Observational, cross-sectional, analytical, multicenter study.

Four percent formalin application for the management of radiation proctitis in carcinoma cervix patients: An effective, safe, and economical practice

Context: Radiotherapy is a very effective treatment modality for pelvic malignancies such as carcinoma of the cervix. However, it is quite common for chronic radiation proctitis (CRP) to manifest after radical radiotherapy. CRP is a source of significant morbidity, and there is a lack of effective treatment modalities. There also exists a general lack of guidelines on management of CRP. Aims: To assess the benefit from 4% formalin application for the treatment of Grade >2 CRP among patients previously treated with radical radiotherapy for cervical carcinoma. Settings and Design: This retrospective descriptive study involved 29 eligible patients who were treated from November 2010 - November 2015 for CRP with 4% formalin application. Materials and Methods: Of the 1864 patients of carcinoma cervix treated during the said patients, 29 patients fulfilled the eligibility criteria. Eligible patients were invited telephonically for follow-up and were assessed for response and complications of the procedure. Results: The treatment of hemorrhagic radiation proctitis with local formalin instillation is effective, well tolerated and safe procedure. The procedure is inexpensive, technically simple and can be done on an outpatient basis. 62% patients had complete freedom from rectal bleed, while 34.5% patients had partial benefit. Only one patient required diversion colostomy for persistent bleeding.