Epidemiology and outcomes of anal abscess in patients on chronic dialysis: a 14-year retrospective study

OBJECTIVES: We conducted this retrospective study to elucidate the clinical presentation and outcomes of anal abscess in chronic dialysis patients. METHODS: We performed a chart review of patients who were hospitalized for anal abscess from Jan. 2002 to Dec. 2015. A total of 3,074 episodes of anal abscess were identified. Of these, 43 chronic dialysis patients with first-time anal abscess were enrolled. Patients were divided into a surgical group and a nonsurgical group according to the treatment received during hospitalization. The baseline characteristics, clinical findings, treatments and outcomes were obtained and analyzed. The endpoints of this study were in-hospital mortality, one-year mortality and one-year recurrence. RESULTS: Of the 43 patients, 27 (62.7%) received surgical treatment, and 16 (37.2%) received antibiotic treatment alone. There was no significant difference in age, sex, body mass index, smoking habits, comorbidities, or dialysis characteristics between the two groups. Perianal abscess was the most common type of anal abscess, and 39.5% of patients experienced fistula formation. Most patients had mixed aerobic and anaerobic flora. Our data demonstrate that there was no significant difference in hospital stay, one-year survival or recurrence rate between the surgical group and nonsurgical group. However, there was a trend toward better in-hospital survival in patients who received surgical treatment (p=0.082). CONCLUSION: In chronic dialysis patients with anal abscess, there was no statistically significant difference in clinical presentation and outcomes between the surgical and nonsurgical groups, although the surgical group had a trend of better in-hospital survival.

Prevalência da lesão HPV induzida em canal anal de mulheres com neoplasia intraepitelial cervical 2 e 3: um estudo de corte transversal / Prevalence of HPV-induced lesions in the anal canal among women with cervical intraepithelial neoplasia 2 and 3: cross-sectional study

OBJETIVO: Determinar a prevalência da lesão anal induzida por HPV em mulheres com neoplasia intraepitelial cervical grau 2/3 (NIC2/3).MÉTODOS: Estudo transversal, realizado no período de dezembro de 2008 a junho de 2009, no Estado de Pernambuco, nordeste do Brasil. Foram incluídas no estudo apenas mulheres com diagnóstico de NIC2/3 confirmado por biópsia e excluídas aquelas que não realizaram exame na primeira visita. As amostras para identificação do DNA de HPV anal por PCR e citologia anal foram coletadas com escovinha endocervical. A biópsia anal foi realizada nos casos de citologia anal anormal ou alterações maiores na anuscopia de alta resolução (AAR).RESULTADOS: Das AARs, 32,1% (n=37/115) foram normais e 63,5% (n=73/115) exibiram epitélio acetobranco. Vinte e dois por cento das citologias anais (n=26/115) foram anormais. Dentre elas, 12,2% (14/26) corresponderam à lesão intraepitelial anal de baixo grau e 3,4% (n=4/26), a lesão intraepitelial anal de alto grau. Foram realizadas 22 biópsias, das quais 13,7% (n=3/22) tiveram diagnóstico de neoplasia intraepitelial anal (NIA2) e 9% (n=2/22), NIA 3. Identificou-se 72,1% (n=83/115) de DNA do HPV nas amostras.CONCLUSÃO: Mulheres com NIC2/3 apresentam elevada prevalência de infecção por HPV e lesão HPV induzida em canal anal.

PURPOSE: To determine the prevalence of HPV-induced lesions in the anal canal of women with cervical intraepithelial neoplasia (CIN) grade 2/3.METHODS: A cross-sectional study was carried out from December 2008 to June 2009, in Pernambuco, northeastern Brazil. Only women with grade 2/3 CIN were included, and those who could not undergo anoscopy during their first visit were excluded. A cyttobrush was used for sample collection in order to identify HPV DNA through PCR and anal cytology. An anal biopsy was obtained in cases of abnormal anal cytology or major alterations in high resolution anoscopy (HRA).RESULTS: Thirty-two percent (n=37/115) of HRA were normal and 63.5% (n=73/115) showed acetowhite epithelium. Twenty-two percent (n=26/115) of anal cytologies were abnormal. Among the latter, 12.2% (n=14/26) were low-grade anal intraepithelial lesions and 3.4% (n=4/26) were high-grade anal intraepithelial lesions. Twenty-two anal biopsies were performed, 13.7% of which (n=3/22) were grade 2 anal intraepithelial neoplasia (AIN2) and 9% (n=2/22) were grade 3 AIN. Th HPV DNA was identified in 72.1% of cases (n=83/115).CONCLUSION: Women with CIN grade 2/3 showed a high prevalence of anal HPV infection and HPV-induced lesions.

Characteristics of Pediatric Inflammatory Bowel Disease in Korea: Comparison with EUROKIDS Data

BACKGROUND/AIMS: Pediatric inflammatory bowel disease (IBD) has been increasing worldwide. The characteristics of pediatric-onset IBD have mainly been reported in Western countries. We investigated the clinical characteristics of pediatric IBD in Korea and compared these with the data from the 5-year European multicenter study of children with new-onset IBD (EUROKIDS registry). METHODS: Children who were diagnosed with IBD between July 1987 and January 2012 were investigated at five Korean university hospitals. Their clinical characteristics were retrospectively evaluated by medical record review. The results were compared with the EUROKIDS data. RESULTS: A total of 30 children with Crohn's disease (CD) and 33 children with ulcerative colitis (UC) were enrolled. In comparison with the EUROKIDS group, Korean pediatric IBD patients showed a male predominance (86.7% vs 59.2%, p=0.002 in CD; 75.8% vs 50%, p=0.003 in UC). Korean pediatric CD patients had a higher prevalence of terminal ileal disease (36.7% vs 16.3%, p=0.004) and perianal disease (33.3% vs 8.2%, p<0.001) than patients in the EUROKIDS group. Korean pediatric UC patients had a higher prevalence of proctitis than patients in the EUROKIDS group. CONCLUSIONS: Our results suggest that the characteristics of Korean pediatric IBD patients and European pediatric IBD patients may be different.

Local control of human papillomavirus infection after anal condylomata acuminata eradication / Controle local da infecção perianal pelo papilomavirus humano após a erradicação dos condilomas acuminados

OBJECTIVE: To verify whether the eradication of anal condylomata acuminata was effective for local control of HPV infection using anal colposcopy and anal brush cytology. METHODS: We evaluated 147 patients treated for anal margin and/or anal canal condyloma, with 108 HIV-positive and 39 HIV-negative individuals. The average age for males was 40 years for HIV-positive and 27.5 for HIV-negative. In females, the mean age was 37.5 years for HIV-positive and 31.5 for HIV-negative. RESULTS: Twenty-four patients (16.3%) had normal cytology and anal colposcopy, 16 (10.9%) normal cytology and altered anal colposcopy, 52 (35.4%) normal anal colposcopy and altered cytology, and 55 (37.4%) had altered cytology and anal colposcopy. CONCLUSION: the eradication of clinical lesions failed to locally control HPV infection. .

OBJETIVO: verificar se a erradicação dos condilomas acuminados perianais foi efetiva no controle local da infecção pelo HPV, utilizando a colposcopia anal e a citologia anal com escova. MÉTODOS: avaliamos 147 pacientes tratados de condiloma da margem e/ou canal anal, sendo 108 HIV-positivos e 39 HIV-negativos. A média etária no sexo masculino foi 40 anos para os HIV-positivos e 27,5 anos para os HIV-negativos. No sexo feminino, a média etária foi 37,5 anos para os HIV positivos e 31,5 anos HIV-negativos. RESULTADOS: vinte e quatro pacientes (16,3%) apresentavam citologia e colposcopia normais, 16 (10,9%) citologia normal e colposcopia alterada, 52 (35,4%) citologia alterada e colposcopia normal e 55 (37,4%) citologia e colposcopia alteradas. CONCLUSÃO: a erradicação das lesões clínicas não controlou localmente a infecção pelo HPV. .

Results of Surgical Treatment on Benign Anal Diseases in Korean HIV-Positive Patients

Perianal diseases are the most common reasons for surgery in HIV-positive patients. This study aimed to evaluate the outcomes of these surgical procedures in Korean patients, focusing on wound healing and postoperative complications. Retrospective analysis was performed on 72 HIV-positive patients who underwent surgery by a single surgeon for benign anal disease between 1998 and 2011. Of these, 68.1% (49/72) of patients received surgery for condyloma acuminata, 19.4% (14/72) for anal fistulas, 6.9% (5/72) for hemorrhoids, and 5.6% (4/72) for perianal abscesses. Patients with condyloma acuminata received surgical excision with electrical coagulation, and all wounds healed completely within 3 months, though 16.3% (8/49) of these patients experienced recurrence. Twelve of the 49 patients (24.5%) who were treated for condyloma acuminata underwent simultaneous operations for concomitant anal fistulas (n = 6), hemorrhoids (n = 4), and perianal abscesses (n = 2). Overall, 3 postoperative complications developed following a total of 94 procedures, and there was no significant increase in complication rate for patients with a low CD4+ T-cell count ( < 200/microL) compared to those with a higher count. The results demonstrate favorable results following perianal surgery in HIV-positive Korean patients.

Fatores de risco para diárreia persistente em lactentes / Risk factors to persistent diarrhea in infants

RACIONAL: A diarréia persistente é uma doença multicausal. A análise do risco para o prolongamento do quadro diarréico envolve variáveis ambientais, biológicas e do manejo clínico. OBJETIVO: Identificar fatores de risco para a diarréia persistente em crianças hospitalizadas na fase aguda do quadro diarréico. PACIENTES E MÉTODOS: O estudo foi do tipo caso-controle. A amostra consistiu de 216 crianças menores de 24 meses hospitalizadas por diarréia de início abrupto, no Instituto Materno-Infantil de Pernambuco, Recife, PE. O grupo de casos incluiu as crianças com diarréia persistente e o de controles aquelas com diarréia aguda. Foram analisadas variáveis socioeconômicas, biológicas, de morbidade anterior, clínicas e do manejo terapêutico prévio à admissão. Utilizou-se o odds ratio não ajustado e ajustado, com seus respectivos intervalos de confiança de 95 por cento, observando-se o nível de significância de 5 por cento. A análise multivariada foi feita através de regressão logística. RESULTADOS: O risco de persistência da diarréia foi maior nas crianças com: disenteria, febre no início do quadro, dieta suspensa e uso de antibiótico à admissão hospitalar. O risco de diarréia persistente foi cerca de três vezes maior para crianças sem geladeira no domicílio e que apresentavam hiperemia perianal ao exame físico na admissão hospitalar, sendo estas as variáveis que apresentaram significância estatística após o ajuste para fatores de confusão. CONCLUSÕES: A melhoria das condições ambientais e o manejo adequado e individualizado da criança hospitalizada por diarréia pode contribuir para a redução da morbidade da doença.

Imágenes en anomalias anorectales / Anorectal malformations images

Las malformaciones anorectales incluyen una amplia variedad de anomalías, de grados variables de complejidad, que con frecuencia se presentan asociadas a otras malformaciones: genitourinarias, espinales, cardíacas, esofágicas y de la pared abdominal entre las más habituales. Las imágenes diagnósticas tienen un importante rol en el estudio de estos pacientes, que está orientado a demostrar adecuadamente la anatomía de la malformación y, por otra parte, precisar la existencia de anomalías asociadas. El examen más utilizado inicialmente en el estudio de pacientes con malformaciones anorectales es el ultrasonido, que posteriormente se complementará con colografía distal, uretrocistografía y resonancia magnética de acuerdo a la condición clínica de cada paciente.

Perianal fistula: retrospective study of surgical treatment of 241 cases

Perianal fistula, usually has a criptoglandular etiology, developing from a perianal abscess and communicating the anal mucosa with the perianal skin. The aim of this paper is to study retrospectively 241 cases of perianal fistula (172 men and 69 women; 2,5:1) aging from 7 and 80 years old (average: 37,4 years), operated on at the Hospital das Clínicas - UFMG, from 1977 to 1996. The surgical techniques and post-operative outcome have been analysed. Perianal abscesses with spontaneous drainage were the predominant etiology (132 patients; 54,8 per cent). Eight percent were submitted to fistulectomy as the first surgical treatment. Among early complications (78; 32,4 per cent), local pain was the most frequent (60; 24,9 per cent). Among the late complications (136; 56,4 per cent) fistula recurrence (101; 41,9 per cent/was the most frequent. There were 141 reoperations in 80 patients. Fistulectomy was the predominant surgical technique employed for the treatment (101; 71,6 per cent). The average hospitalization time was 6,3 days until 1990 and 1,5 day from 1991 to 1996, after the advent of day-surgery beds in HC-UFMG. The surgical treatment of perianal fístula has a significant rate of post-operative complications and a high recurrence rate, in spite of the short stay in hospital.

Complicaciones infecciosas de la enfermedad inflamatoria anorrectal / Infectious complications of the inflammatory anorectal disease

Introducción. Las infecciones de la región anorrectal puede ser un problema grave y a menudo se asocian con falla orgánica múltiple. Objetivo. Presentar nuestra experiencia sobre infecciones anorrectales en un hospital de tercer nivel de atención en la ciudad de México. Pacientes y métodos. Analizamos retrospectivamante los datos de todos los pacientes que ingresaron consecutivamente a un Hospital de Infectología de tercer nivel de atención de 1991 a 1994. Se evaluó la edad, sexo severidad de la enfermedad, enfermedades asociadas, gérmenes aislados y mortalidad. Resultados. Estudiamos 157 pacientes (36 mujeres, 121 hombres, de 2-87 años); se encontró fascitis necrotizante en 100, gangrena de Fournier en 48 e infecciones retroperitoneales en nueve. La diabetes mellitus y el alcoholismo estuvieron presentes en los pacientes inmunocomprometidos. La E. coli fue el germen que se aisló con más frecuencia (58.7 por ciento). La mayoría de los pacientes fueron tratados con penicilina G intravenosa, amikacina y metronidazol y se efectuaron en total 1,002 procedimientos quirúrgicos. Las complicaciones de la enfermedad anorrectal fueron: cetoacidosis diabética, insuficiencia renal aguda y falla orgánica. La mortalidad fue de 49 por ciento. Conclusión. Las infecciones en el huésped comprometido se asocian frecuentemente con falla orgánica múltiple en nuestro país

Fistula ano rectal

Entre enero de 1992 a enero de 1993, fueron operados 30 pacientes de fístula anal, 18 eran hombres y 12 mujeres, con una edad media de 41 años. Se ha utilizado la clasificación de Parks encontrándose 50 por ciento de fístula interesfintérica, 40.5 por ciento transesfintérica, 6.2 por ciento subcutánez y 3.5 por ciento supraesfintérica. La regla de Goodsall se cumple en un 93.3 por ciento de casos (p 00.1). La tasa de recidiva e incontinencia fue nula y 6.6 por ciento respectivamente. Se concluye que la clsificación de Parks y la regla de Goodsall es muy útil en la cirugía de la Fístula. La recurrencia resulta de una falla de la exposición de todo el trayecto fistular.

Estrechez anal postoperatoria y lesiones leucoplasicas

En este trabajo presentamos 35 casos de estenosis anal postoperatoria, operados en el Sanatorio del Sur de Bahía Blanca, Argentina, en los últimos nueve años (1978-1986. En 9 de ellos (el 25,7%) el informe anatomopatológico de las biopsias efectuadas fue: lesiones leucoplásicas del ano y canal anal. Destacamos la anatomía patológica de estos casos y aconsejamos, dado el carácter preneoplásico de la leucoplasia, el envío al anatompatólogo de todos los casos operados de patología benigna del ano, lo que representaría la profilaxis más segura del cáncer de ano

Constipación de causa anal / Constipation due to anal causes

Entre los niños presentan una constipación crónica rebelde al tratamiento médico, hay un grupo en los cuales el tacto rectal revela la presencia de un fecaloma y el estudio radiológico demuestra un retardo de la evacuación y la presencia de un megarrecto con o sin megacolon. La constipación en estos casos puede ser secundaria a un trastorno funcional de larga data o bien obedece a diversas anomalías de la región anal. En esta revisión se analizan estas anomalías, el método de estudio, diagnóstico diferencial y tratamiento

Celulitis necrotizante como complicación de un absceso perianal (Síndrome de Fournier): caso reportado / Necrotizing cellulitis as complication of perianal abscess (Fournier syndrome): report of a case

Es presentado un caso de celulitis necrotizante, como complicación de un absceso perianal. Revisamos la bibliografía estableciendo comparaciones con casos similares, dando recomendaciones respecto al manejo de esta entidad nosológica