Anal mycobacterial infections / Infecções micobacterianas do ânus

Abstract Background Mycobacterial infections are a serious public health problem worldwide. Involvement of the anal canal and perineum is very rare, but constitute an important differential diagnosis with other equally serious pathologies that may affect the region, such as malignant neoplasms and Crohn's disease. Objectives To conduct a literature review on mycobacterial infections of the perianal region considering the most recent information for diagnostic and therapeutic guidance of this disease. Methods Research was performed on the PUBMED and LILACS databases with the expressions Mycobacterium, Anal, Infection and Tuberculosis. We reviewed articles referring to series of treated cases, clinical reports and literature review published since 2005. Results Information was compiled on the epidemiology of mycobacterial infections; the clinical behavior of affected individuals; diagnostic options and their validity in clinical practice; and, finally, therapeutic options. Conclusions Mycobacterial infections of the anus and perineum are rare. The most common clinical presentations are the presence of ulceration and fistulization. The diagnosis involves more than one procedure for identifying the bacilli and should consider the presence of manifestations in more than one organ. The treatment is based on pharmacological intervention. Surgery is recommended for acute complications or chronic sequelae of the disease.

Resumo Introdução Infecções micobacterianas constituem um grave problema de saúde pública a nível mundial. As manifestações anoperineais são raras, mas constituem um importante diagnóstico diferencial com outras patologias igualmente graves que podem acometer a região, como as neoplasias malignas e a doença de Crohn. Objetivos Realizar um levantamento da literatura sobre infecções micobacterianas da região anoperineal, considerando as informações mais atuais para orientação diagnóstica e terapêutica dessa enfermidade. Métodos Foi realizada pesquisa nos bancos de dados PUBMED e LILACS com as expressões Mycobacterium, Anal, Infection e Tuberculosis. Foram revisados artigos referentes a séries de casos tratados, relatos clínicos e revisão da literatura publicada a partir de 2005. Resultados Foram compiladas informações sobre a epidemiologia das infecções micobacterianas; o comportamento clínico dos indivíduos afetados; opções diagnósticas e sua validade na prática clínica; e, por fim, opções terapêuticas. Conclusões Infecções micobacterianas da região anoperineal são raras. As apresentações clínicas mais comuns são a formação de ulceras e a fistulização. O diagnóstico envolve mais de um procedimento para identificação dos bacilos, e deve considerar a presença de manifestações em mais de um órgão. O tratamento é principalmente medicamentoso, sendo a cirurgia recomendada nas complicações agudas ou sequelas crônicas da doença.

Anodispareunia. Dolor anal durante las relaciones sexuales anorreceptivas en hombres que tienen sexo con hombres / Anodyspareunia. Anal pain during anoreceptive sex in men who have sex with men

Introducción: La región perianal es un área muy rica en terminaciones nerviosas sensitivas, hecho que determina que el erotismo anal sea frecuente, independientemente de la identidad y orientación sexuales. Pese a ello, el impacto del sexo anal receptivo (SAR) en la salud anal ha sido poco estudiado. Algunas personas experimentan dolor durante las relaciones sexuales anorreceptivas. Los objetivos del presente trabajo fueron evaluar su prevalencia en una muestra del colectivo de hombres que tienen sexo con hombres (HSH) residentes en la Argentina, e identificar potenciales factores asociados a su aparición.Diseño: Estudio descriptivo, transversal.Población y método: Se diseñó una encuesta que incluyó variables demográficas y factores relacionados con el SAR. Fue respondida de forma voluntaria y anónima por Internet entre marzo de 2015 y febrero de 2016. Se incluyeron HSH mayores de 18 años residentes en la Argentina, que hubieran practicado SAR durante las últimas cuatro semanas. Se realizaron análisis estadísticos bivariados y multivariados en modelos de regresión logística. Resultados: Respondieron la encuesta 208 HSH. Se seleccionaron para el análisis 135 (64,9%) que acreditaron haber mantenido SAR en las últimas cuatro semanas. El 76,3% pertenecía a la Ciudad Autónoma de Buenos Aires y Provincia de Buenos Aires. El 92,6% tenía estudios superiores. El 88,9% manifestó experimentar algún nivel de dolor durante el SAR, siendo grave en el 5,5% de los casos. En el análisis bivariado se identificaron como variables asociadas al desarrollo de dolor: "edad", "edad de inicio de las relaciones sexuales en general", "miedo a sufrir dolor", "fisting" y "miedo al ensuciamiento". En el modelo multivariado surgieron como potenciales factores de riesgo, "edad de salida del placard", "miedo a sufrir dolor" y "uso de poppers". Como posibles factores protectores, "fisting", "edad al momento del estudio" y "edad de inicio de relaciones con otros hombres". Conclusiones: Este estudio se focalizó en la anodispareunia experimentada específicamente por el colectivo homosexual masculino en Argentina. El 88,8% experimentó algún nivel de dolor, siendo grave en el 5,5%. Como en otros estudios, en éste se identificaron posibles factores predisponentes, algunos modificables y otros no. Un mayor conocimiento de los potenciales factores influyentes permitirá un mejor asesoramiento de los profesionales sanitarios a la población afectada sobre prevención del dolor en particular y sobre el erotismo anal en general. (AU)

Introduction: The perianal region is very rich in sensory nerve endings, which determines that anal erotism is frequent, regardless of sexual identity and sexual orientation. Despite this, the impact of receptive anal sex (RAS) on anal health has been little studied. Some people experience pain during anoreceptive sex. The objectives of this study were to evaluate its prevalence in a sample of men who have sex with men (MSM) resident in Argentina and identify potential factors associated with its appearance.Design: Descriptive, transversal study.Population and method: A voluntary and anonymous survey was designed. It included demographic variables and factors related to RAS. It was answered on the Internet between March 2015 and February 2016. MSM over 18 years of age resident in Argentina, who had practiced RAS during the last four weeks, were included. Bivariate and multivariate statistical analyzes were performed in logistic regression models.Results: Two hundred and eight MSM answered the survey. One hundred and thirty-five (64.9%) who had maintained RAS in the last four weeks were selected for the analysis. 76.3% belonged to the Ciudad Autónoma de Buenos Aires and the Buenos Aires Province. 92.6% had higher education. 88.9% reported that they experienced some level of pain during RAS, being severe in 5.5% of cases. In the bivariate analysis were identified as variables associated with the development of pain: "age", "age of onset of sexual relations in general", "fear of suffering pain", "fisting" and "fear of getting dirty". In the multivariate model, the "age of coming out", the "fear of suffering pain" and the "use of poppers" appeared as possible risk factors. As possible protective factors, "fisting", "outing age", "age" and "age when starting relationships with other men". Conclusions: This study focused on the anodyspareunia experienced specifically by the male homosexual group in Argentina. 88.9% experienced some level of pain, being severe in 5.5%. As in other studies, possible predisposing factors have been identified in this one; some modifiable and others not. A greater knowledge of the potential influential factors will allow a better advice of health professionals to the affected population on pain prevention and on anal erotism in general. (AU)

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.

Incidence, psychosocial burden, and economic impact of genital warts in Mexico / Incidencia, carga psicosocial e impacto económico de las verrugas genitales en México

Abstract: Objective: To estimate the burden of genital warts (GW) in Mexico. Materials and methods: We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. Results: The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. Conclusions: This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.

Resumen: Objetivo: Estimar la carga por verrugas genitales (VG) en México. Material y métodos: Estimamos la incidencia anual de VG, con base en información proporcionada por médicos especialistas y el manejo de las VG, así como el costo promedio del tratamiento y la carga psicosocial de las VG. Resultados: La incidencia anual de VG en México fue de 547 200 casos. Los tratamientos variaron según la especialidad y el sexo del paciente. El costo anual por VG fue de $195 millones de dólares estadounidenses. El impacto psicosocial de las VG es ligeramente mayor en hombres que en mujeres. Conclusiones: Esta es la primera evaluación de la carga de VG en México. Los datos sugieren que las VG son frecuentes, tienen costos relacionados con salud e impactos psicosociales significativos.

Prevalence and incidence of anal human papillomavirus infection in Mexican men: Need for universal prevention policies / Prevalencia e incidencia de infección por virus de papiloma humano en canal anal en hombres mexicanos: Necesidad de políticas de prevención universal

Abstract: Objective: Describe the natural history of anal HPV among men. Materials and methods: Prospective study among men 18-70 years (n=665), from Cuernavaca, Mexico who completed questionnaires and provided specimens (HPV genotyped) at enrollment and 1+ follow-up visit. HPV prevalence and incidence were estimated. Prevalence ratios were calculated with Poisson regression using robust variance estimation. Person-time for incident HPV infection was estimated using number of events modeled as Poisson variable for total person-months. Results: Anal infection prevalence: any HPV type=15%, high-risk=8.4%, HPV16=1.4%, tetravalent vaccine types (4vHPV)=4.4%, nonavalent vaccine types (9vHPV)=6.3%. Factors associated with prevalence: 50+ lifetime female sex partners (adjusted prevalence ratio, a PR=3.25, 95% CI:1.12-9.47), 10+ lifetime male sex partners (aPR=3.06, 95%CI:1.4-6.68), and 1+ recent male anal sex partners (aPR=2.28, 95%CI:1.15-4.5). Anal incidence rate: high-risk HPV=7.8/1 000 person-months (95%CI:6.0-10.1), HPV16=1.8/1 000 person-months (95%CI:1.1-2.9),4vHPV=3.4/1 000 person-months (95%CI:2.3-4.9) and 9vHPV=5.5/1000 person-months (95%CI:4.1-7.5). Conclusions: Implementation of universal HPV vaccination programs, including men, is a public health priority.

Resumen: Objetivo: Generar evidencia que apoye la vacunación universal contra VPH. Material y métodos: Estudio prospectivo con hombres 18-70 años (n=665) de Cuernavaca, México con cuestionarios y genotipificación de VPH en muestras (2+mediciones). Se estimó prevalencia e incidencia; se calcularon tasas de prevalencia con regresión Poisson. Se estimó persona-tiempo para infecciones incidentes. Resultados: Prevalencia de infección anal: cualquier tipo de VPH=15%, alto-riesgo=8.4%, VPH16=1.4%, tipos en vacuna tetravalente=4.4% y tipos en vacuna nonavalente=6.3%. Factores asociados con infección prevalente: 50+ parejas sexuales femeninas en la vida (tasa de prevalencia ajustada, TPa=3.25, IC95%:1.12-9.47); 10+ parejas sexuales masculinas en la vida (TPa=3.06, IC95%:1.4-6.68) y 1+ parejas masculinas (sexo anal) recientes (TPa=2.28, IC95%:1.15-4.5). Tasas de incidencia para infección anal: VPH alto-riesgo=7.8/1000 persona-meses (IC95%:6.0-10.1), VPH 16=1.8/1000 persona-meses (95%IC:1.1-2.9), tipos en vacuna tetravalente=3.4/1000 persona-meses y tipos en vacuna nonavalente=5.5/1000 persona-meses. Conclusiones: Implementación de programas de vacunación universal (incluyendo hombres) contra VPH es una prioridad en salud pública.

Prevalence and risk factors for oral human papillomavirus infection in Mexican HIV-infected men / Prevalencia y factores de riesgo para infección oral con virus de papiloma humano en hombres mexicanos con VIH

Abstract: Objective: To determine the prevalence and risk factors for oral high-risk human papillomavirus (HR-HPV) infection in human immunodeficiency virus(HIV)-infected men. Materials and methods: Consecutive male outpatients with HIV-infection were enrolled. Demographic and behavioral risk data were obtained. Anal swabs and oral rinses were tested for HR-HPV DNA. Oral, pharyngeal and video laryngoscopy examinations were performed for detection of lesions. Results: The prevalence of HR-HPV oral infection was 9.3% (subtypes other than HR HPV 16/18 predominated). The prevalence of anal HR-HPV infection was 75.7%. The risk factors for oral infection with HR-HPV were tonsillectomy (OR=13.12) and years from HIV diagnosis (OR=1.17). Conclusions: Tonsillectomy and years from HIV diagnosis were associated with oral HPV infection. No association was found between oral and anal HR-HPV infections. This is the first study reporting the prevalence and risk factors for oral HR-HPV infection in Mexican HIV-infected population.

Resumen: Objetivo: Determinar la prevalencia y los factores de riesgo para infección oral por virus de papiloma humano de alto riesgo (VPH-AR) en individuos con VIH. Material y métodos: Se incluyeron pacientes ambulatorios consecutivos con VIH. Se recabó información demográfica y sobre factores de riesgo conductuales. Se detectó DNA de VPH-AR en hisopado rectal y enjuague bucal. Se efectuó exploración de boca, faringe y videolaringoscopía para detectar lesiones. Resultados: La prevalencia de VPH-AR oral fue 9.3% (predominaron subtipos diferentes de VPH-AR 16/18). La prevalencia de VPH-AR anal fue 75.7%. Los factores de riesgo para VPH-AR oral fueron la tonsilectomía (OR=13.12) y los años de diagnóstico del VIH (OR=1.17). Conclusiones: La tonsilectomía y los años de diagnóstico del VIH se asociaron con VPH-AR oral. No hubo asociación entre VPH-AR oral y anal. Este es el primer reporte sobre prevalencia y factores de riesgo para VPH-AR oral en población mexicana con VIH.

Perianal abscess: a descriptive analysis of cases treated at the Hospital Santa Marcelina, São Paulo / Abscesso perianal: análise descritiva de casos atendidos no Hospital Santa Marcelina, São Paulo

Abstract Introduction Perianal suppurations have an incidence of 1-2:10,000 inhabitants per year and represent about 5% of proctology consultations, more frequently in males, being rare in childhood. Although perianal or anorectal abscess is an entity of relatively simple diagnosis and treatment, in a considerable percentage of patients difficulties will be found, especially considering that the initial treatment of these patients is performed by non-specialist physicians. Objective This is a retrospective survey of cases of perianal and anorectal abscess operated in Santa Marcelina Hospital between October 2011 and December 2014. Patients and methods A retrospective study of patients operated on an emergency basis for perianal and/or anorectal abscess in Santa Marcelina Hospital between October 2011 and December 2014, being excluded patients with inflammatory bowel disease. Data of gender, age, clinical presentation, the season of the year in which the abscess occurred, time of progression of symptoms, comorbidities, signs of Systemic Inflammatory Response Syndrome (SIRS) on admission, surgeries carried out, reoperations and clinical outcome were analyzed. Results Electronic medical records of 52 patients (73.1% male) who underwent surgical treatment of anorectal and perianal abscess were analyzed. The mean overall age was 43.03 years, and all patients reported pain as the main symptom, with a mean time of symptoms of 6.5 days. As for the season of the year of onset and diagnosis of perianal abscess, 61.5% of patients had this pathology in the summer and spring months. Conclusion In our study, it can be observed a higher incidence of perianal abscess in males and in the warmer months; furthermore, just over half of the patients developed perianal fistula in their progression.

Resumo Introdução As supurações perianais apresentam uma incidência de 1-2:10000 habitantes por ano e representam cerca de 5% das consultas proctológicas, com maior frequência no sexo masculino, sendo raras na infância. Embora o abscesso perianal ou anorretal seja de diagnóstico e tratamento relativamente simples, uma percentagem considerável representa maior dificuldade para tal, notadamente pelo fato do atendimento inicial desses pacientes ser realizado por médicos não especialistas. Objetivo Levantamento retrospectivo dos casos de abscesso perianal e anorretal operados no Hospital Santa Marcelina entre outubro de 2011 e dezembro de 2014. Casuística e método Estudo retrospectivo de pacientes operados em caráter de urgência por abscesso perianal e/ou anorretal no Hospital Santa Marcelina entre outubro de 2011 e dezembro de 2014, excluídos portadores de doença inflamatória intestinal. Analisaram-se dados de sexo, idade, quadro clínico, época do ano da ocorrência do abscesso, tempo de evolução dos sintomas, comorbidades, sinais de Síndrome da Resposta Inflamatória Sistêmica (SIRS) na admissão, cirurgias realizadas, reoperações e desfecho clínico. Resultados Foram analisados prontuários eletrônicos de 52 pacientes submetidos à tratamento cirúrgico de abscesso anorretal e perianal, dos quais 73,1% pertenciam ao sexo masculino. A média de idade geral foi de 43,03 anos e todos os pacientes relataram dor como sintoma principal com média de tempo de sintomatologia de 6,5 dias. Quanto à época do ano do aparecimento e diagnóstico do abscesso perianal, 61,5% dos pacientes apresentaram a patologia nos meses de verão e primavera. Conclusão Em nosso trabalho, pode-se observar maior incidência de abscesso perianal no sexo masculino e nos meses mais quentes e que pouco mais da metade dos pacientes desenvolveram fístula perianal na evolução.

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.

Perfil epidemiológico, clínico y endoscópico de los pacientes con sintomatología anorrectal en el Hospital Nacional Arzobispo Loayza 2013 / Epidemiological, clinical and endoscopic profile of patients with anorectal symptoms in National Hospital Arzobispo Loayza 2013

INTRODUCCION: Las enfermedades anorrectales benignas son bastante comunes entre la población general; aunque la incidencia exacta se desconoce, se estima una prevalencia global de 3-7 por ciento en Estados Unidos. La mayoría de estas enfermedades afectan significativamente la calidad de vida del pacientes en nuestro medio no están claramente definidas las diferentes características de estas patologías, por lo tanto el objetivo de este estudio es conocer las características de este problema de Salud. OBJETIVO GENERAL: Determinar las características: epidemiológicas, clínicas, y endoscópicas de los pacientes con sintomatología anorrectal. METODOLOGIA: Estudio Descriptivo, Transversal, Prospectivo de Serie de Casos. Se realizaron 181 encuestas en pacientes que accedieron a la entrevista luego de ser evaluados en la sala de procedimientos de Endoscopia Digestiva Baja del Servicio de Gastroenterología del Hospital Nacional Arzobispo Loayza, en los meses de Mayo y Junio 2013, luego de la evaluación e indicación de procedimiento se aplicó la encuesta respectiva. RESULTADOS: La Rectorragia es el síntoma y signo predominante, siendo la edad promedio 49 años de edad, predominando el sexo femenino, la mayoría era instruido, con ocupación frecuente de actividades elementales: amas de casa, trabajadores de limpieza, estibadores y ambulante; un tercio de la población estudiada acude a la consulta médica entre 1 a 5 años después de iniciados sus molestias, siendo el Estreñimiento, la patología concomitante más frecuente. Las 5 primeras patologías anorrectales fueron Enfermedad Hemorroidal (64.09 por ciento), Pólipos en Recto (5.52 por ciento), Fisura anal (5.52 por ciento), Pólipos en Colon (4.97 por ciento) y Fístula anal (4.97 por ciento).

INTRODUCTION: Benign Anorectal diseases are quite common among the general population, although the exact incidence is unknown, the estimated overall prevalence of 3-7 per cent in the United State. Most of these diseases significantly affect the quality of life of patients, in our environment are not clearly defined the different characteristics of these diseases, therefore the aim of this study was to determine the characteristics of this health problem. GENERAL PURPOSE: To determine the characteristics: epidemiological, clinical, and endoscopic patients with Anorectal symptoms. METHODOLOGY: Descriptive, Cross, Prospective Case Series. 181 surveys were conducted in patients who agreed to the interview after being evaluated in the procedure room Lower Digestive Endoscopy Gastroenterology National Hospital Arzobispo Loayza in the months of May and June 2013, after evaluation procedure and indication respective survey was applied. RESULTS: Rectal bleeding is the predominant symptom and sign, the average age being 49 years of age, predominantly female, most were educated with basic activities common occupation: housewife, cleaning workers, dockers and itinerant, a third of the study population comes to the medical consultation between 1-5 years after his troubles started, with Constipation, the most common concomitant condition. The first 5 were Anorectal Pathology Hemorrhoidal Disease (64.09 per cent), polyps in Recto (5.52 per cent), anal fissure (5.52 per cent), colon polyps (4.97 per cent), and anal fistula (4.97 per cent).

Verrugas anogenitales y sospecha de abuso sexual infantojuvenil / Anogenital warts and suspicion of child sexual abuse

El presente trabajo se refiere a las lesiones por verrugas anogenitales producidas por el virus de papiloma humano (HPV) en niños. Describe el diagnóstico, la epidemiología, los modos de transmisión, los diagnósticos diferenciales y su relación con el cáncer a largo plazo; también, la presencia de verrugas anogenitales como indicador de abuso sexual infantojuvenil. Finalmente, incluye sugerencias para el pediatra en el manejo de estos pacientes y sus familias.

This article deals with anogenital warts (AGW) injuries caused by human papiloma virus (HPV) in children. Diagnosis, epidemiology, modes of transmission, differential diagnosis, relationship between AGW and cancer are descript. Also, it remarks the presence of AGW as indicator of child sexual abuse. Finally, it includes suggestions for the management of patients and their families by the paediatrician.

Prevalencia de patología ano-rectal en pacientes portadores de VIH/SIDA / Prevalence of ano-rectal pathology in HIV/AIDS patients

Introduction: The ano-rectal pathology (ARP) is the most common surgical condition in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Our aim was to determine the current prevalence and clinical characteristics of the ARP in patients with HIV/AIDS in clinical control in the infectious diseases unit of the Hernán Henríquez Aravena Hospital in Temuco. Patients and Method: Study design: Cross section. Location and period: Infectious Diseases Unit of the hospital during the month of June 2010. Inclusion criteria: Patients with HIV/AIDS under control in the unit, medical records were analyzed and complete physical examination was performed. Results: In the period of study 384 patients were in control in the unit. Fifty had ARP which is a prevalence of 13%. Anal condyloma disease and hemorrhoidal disease were the most common diseases. Most patients (76%) were on antiretroviral therapy with good clinical response. Conclusion: The prevalence of ARP in HIV/AIDS patient has increased in recent years. This study shows a change in the pattern of presentation, being anal condyloma the most common ARP.

Introducción: La patología ano-rectal (PAR) es la afección quirúrgica más frecuente en pacientes portadores del virus de la inmunodeficiencia adquirida (VIH) y del síndrome de la inmunodeficiencia adquirida (SIDA). Nuestro objetivo fue determinar la prevalencia actual y las características clínicas de la PAR en pacientes portadores de VIH/SIDA en control clínico en la unidad de infectología del Hospital Doctor Hernán Henríquez Aravena de Temuco. Materiales y Método: Diseño de estudio: Corte transversal. Lugar y período: Unidad de Infectología del Hospital Doctor Hernán Henríquez Aravena de Temuco durante el mes de junio de 2010. Criterios de inclusión: Pacientes portadores de VIH-SIDA en control en la unidad, se analizó su historial clínico y se realizó un examen físico completo. Resultados: Durante el período 384 pacientes se encontraban en control en la unidad. Cincuenta presentaron PAR lo que constituye una prevalencia del 13%. La condilomatosis anal y la enfermedad hemorroidal fueron las patologías más frecuentes. La mayoría de los pacientes (76%) se encontraban en terapia anti-retroviral y con buena respuesta clínica. Conclusión: La prevalencia de patología ano-rectal en pacientes portadores de VIH/ SIDA se ha incrementado en los últimos años. Se aprecia un cambio en las características clínicas de presentación, siendo la condilomatosis anal la PAR más frecuente.

Infecciones graves del periné: unificación de conceptos / Perineal severe infections: concepts unification

Esta monografía se refiere a diferentes procesos que se caracterizan por una inflamación progresiva de la región perineal que llega a la necrosis de la piel, el tejido celular subcutáneo y ocasionalmente el músculo, generando una severa toxicidad sistémica. Es necesario agruparlos bajo la denominación de “infecciones graves del periné” teniendo en cuenta su forma similar de presentación, el diagnóstico precoz que merecen, y el tratamiento exhaustivo del que depende su curación. Existen factores predisponentes, como la diabetes mellitus, y otros desencadenantes, como los procedimientos invasivos locorregionales, que favorecen la aparición de esta afección. Las causas más frecuentes son infecciones anorrectales, genitourinarias y lesiones traumáticas. Casi todos los casos se caracterizan por presentar flora bacteriana mixta y sinérgica. En los cultivos se identifican organismos anaerobios y aerobios facultativos. El diagnóstico se basa en los hallazgos clínicos. La utilidad de las imágenes se limita al diagnóstico precoz de lesiones que potencialmente pueden dar lugar al surgimiento de esta entidad, y a la búsqueda de colecciones que han pasado desapercibidas. La bacteriología provee las bases para ejercer un programa de tratamiento de rutina. El tratamiento debe ser instaurado inmediatamente. La buena evolución de esta grave patología se basa en las medidas urgentes y generales de reanimación, compensación y sostén, antibióticoterapia adecuada, y con una cirugía que siempre debe ser precoz y agresiva. El impacto de la terapia coadyuvante con oxígeno hiperbárico en cuanto a mejoras en los resultados permanece en controversia. Con respecto a la cirugía reparadora, debe tenerse en cuenta que el realizar un debridamiento agresivo, conlleva acarrear con malos resultados estéticos y dificultad en la cicatrización del lecho quirúrgico...

This work talks about different processes that characterize by a progressive inflammation of the perineal region which includes skin, hypodermis and occasionally the muscle necrosis, generating a severe general toxicity. It is necessary to group them under the denomination of “serious infections of perineum” considering its similar form of presentation, the precocious diagnosis needed, and the exhaustive treatment that depends its treatment. There are many helping factors, such as diabetes mellitus, and other leading ones, like regional invasive procedures, which help to promote this affection. The most frequent causes are anorectal and genitourinary infections, and traumatic injuries. Almost all cases are characterized by displaying mixed and sinergical bacterial flora. Anaerobic and facultative aerobic organisms are identified in tissue cultures. The diagnosis is based on the clinical findings. The utility of images is limited to the precocious diagnosis of injuries that can give rise to the sprouting of this illness, and the search of unnoticed collections. Bacteriology provides the bases to start a program of routine treatment. Treatment must be restored immediately. The favorable evolution of this serious pathology is based on urgent and general measures of resuscitation, suitable antibiotic therapy, and surgery, that always must be precocious and aggressive. The impact of helping hyperbaric oxygen therapy as far as improvements in results remains in controversy. As far as repairing surgery, it must be consider that making an aggressive surgery entails to carry with bad aesthetic results and difficulties in the cicatrization of the surgical wound. This fact does not have to be more important than the initial therapeutic success, which will save of the patient's life. Without a suitable handling, the perineum severe infections present a terrible prognosis, with high mortality rate and anatomic and functional sequels that causes invalidity.

Enfermedad de Crohn perianal / Perianal Crohn's disease

Antecedentes: El manejo de las manifestaciones perianales en la enfermedad de Crohn es dificultoso. Su frecuencia varia entre 6 y el 34 por ciento. El tratamiento conservador es lo sugerido. En la actualidad esto se ve favorecido por los nuevos tratamientos con drogas inmunosupresoras. Objetivo: Actualizar los conceptos básicos sobre el tratamiento médico y quirúrgico de la enfermedad de Chron perianal. Material y Método: Revisión bibliográfica a través de bases de datos MEDLINE, COCHRANE y PUBMED. Resultados: Se incluyen bajo la denominación de enfermedad de Crohn perianal aquellas manifestaciones perianales concomitantes con la enfermedad, o compatibles con dicho diagnóstico en ausencia de la misma. Su frecuencia varia según los criterios de inclusión utilizados. La clasificación anatómica de Cardiff y el índice de actividad de la enfermedad perianal de la Universidad de McMaster son las más apropiadas para el manejo de los pacientes. La estrategia diagnóstica debe enfocarse en evaluar la extensión y actividad de la enfermedad. Las modalidades más utilizadas son el examen bajo anestesia, la resonancia magnética y la ecografía endorrectal. El tratamiento debe ser siempre individualizado y, en general, lo más conservador posible. Conclusión: La enfermedad de Crohn perianal debe ser correctamente evaluada para su tratamiento. Los nuevos tratamientos con drogas inmunosupresoras han mejorado su evolución, permitiendo un manejo conservador con buenos resultados.

Doenças anais concomitantes à doença hemorroidária: revisão de 1.122 pacientes / Anal diseases associated to hemorrhoids: review of 1.122 patients

Em 34.000 pacientes coloproctológicos foi feito o diagnóstico de doença hemorroidária (DH), como doença coloproctológica principal, em 9.289 pacientes (27,3 por cento), dos quais 1.122 (12,1 por cento) eram portadores de doenças anais concomitantes à DH (DAC). Dos 9.289 portadores de DH, 2.417 foram operados de DH (26,0 por cento) e destes, 729 foram operados, ao mesmo tempo, de DAC (30,2 por cento). Assim, dos 1.122 portadores de DAC, 729 foram operados delas (65,0 por cento). Em relação aos 9.289 portadores de DH, a DAC mais comum foi a fissura anal (541 casos, 5,8 por cento), seguida de hipertrofia de papilas anais (312 casos, 3,4 por cento), fístulas anais (117 casos, 1,3 por cento), hipotonia anal com incontinência parcial (112 casos, 1,2 por cento), condilomas anais acuminados (37 casos, 0,4 por cento) e tumores anais (3 casos, 0,03 por cento); e a mesma ordem foi verificada em relação às 1.122 DAC: fissura anal (48,2 por cento), hipertrofia de papilas anais (27,8 por cento), fístulas anais (10,4 por cento), hipotonia anal com incontinência parcial (10,0 por cento), condilomas anais acuminados (3,3 por cento) e tumores anais (0,3 por cento). Em relação à cirurgia, das 1.122 DAC 729 foram operadas (65,0 por cento) nesta ordem: fissura anal (317 casos, 28,3 por cento), hipertrofia de papilas anais (267 casos, 23,8 por cento), fístulas anais (89 casos, 7,9 por cento), hipotonia anal com incontinência parcial (31 casos, 2,8 por cento), condilomas anais acuminados (22 casos, 1,9 por cento) e tumores anais (3 casos 0,3 por cento); e em relação às próprias DAC as incidências de cirurgias foram: tumor anal (100,0 por cento), hipertrofia de papilas anais (85,6 por cento), fístulas anais (76,0 por cento), condilomas anais acuminados (59,6 por cento), fissuras anais (58,6 por cento) e hipotonia com incontinência anal parcial (25,8 por cento). A confirmação dos diagnósticos das DAC pelo exame histopatológico foi de 72,8 por cento, em ordem...

In a 38-year period of practice in Coloproctology, the author had the opportunity to attend 34,000 patients and the diagnosis of hemorrhoid as the main cause of the symptoms presented was achieved in 9,289 patients (27.3 percent) being hemorrhoid associated with several anorectal diseases in 1,122 patients (12.1 percent). 2,417 patients of the patients underwent hemorrhoidectomy (26.0 percent) and 729 of theese patients were operated on for associated anal diseases at the same time (65.0 percent). The most frequently diagnosed associated anal diseases were anal fissures (541 cases, 5.8 percent) and hyperthrofied anal papila (312 cases, 3.4 percent) folowed by anal fistulae (117 cases, 1.3 percent), partial fecal incontinence (112 cases, 1.2 percent), anal condyloma (37 cases, 0,4 percent) and anal tumors (3 cases, 0,03 percent). The same order of incidence was verified in relation to the 1,122 cases of associated anal diseases: anal fissures (48.2 percent), hyperthrofied anal papila (27.8 percent), anal fistulae (10.4 percent), partial fecal incontinence (10.0 percent), anal condyloma (3.3 percent) and anal tumors (0,3 percent). As far as associated anal diseases are concerned (1,122 cases), the incidence of surgery was 65.5 percent (729 patients) in this order: fissurectomy (317 cases, 28.3 percent), anal papilectomy (267 cases, 23.8 percent), anal fistulectomy (89 cases, 7.9 percent), partial fecal incontinence (31 cases, 2.8 percent), resection of anal condylomata (22 cases, 1.9 percent), resection of anal tumors (3 cases, 0.3 percent). And as far as each associated anal disease is concerned the incidence of surgery was the following: resection of anal tumors (100,0 percent), papilectomy (85.6 percent), fistulectomy (76.0 percent), resection of anal condylomata (59.6 percent), fissurectomy (58.6 percent) and partial fecal incontinence (25.8 percent). Associated anal diseases with the highest proportion of confirmation of proctologic...

Trombose perianal não se relaciona com doença hemorroidária / Perianal thrombosis is not related to hemorrhoidal disease

Trombose perianal é uma das causas mais frequentes de consulta em coloproctologia. Apesar desta alta incidência, esta condição tem recebido pouca atenção da literatura e sua fisiopatologia é ainda motivo de controvérsia. Um estudo prospectivo foi realizado em oitenta pacientes consecutivos com trombose perianal para definir seus aspectos clínicos, condições associadas e implicações potenciais na fisiopatologia. Em 45 pacientes (56 por cento) foi possível detectar algum possível agente desencadeante, principalmente um grande esforço físico (32 por cento). Sessenta e quatro pacientes (80 por cento) referiram hábito intestinal normal. Sintomas prévios de doença hemorroidária foram referidos por apenas oito pacientes (10 por cento) e nenhuma evidência de doença hemorroidária foi observada na anuscopia de 55 (69 por cento). Quarenta e um pacientes (51 por cento) tinham experimentado episódios prévios de trombose perianal. Avaliação microscópica de três espécimes excisados mostraram uma posição intravascular do trombo. Concluiu-se deste estudo que a trombose perianal não está relacionada com a doença hemorroidária. Ele também sugere a hipótese de que a fisiopatologia da trombose perianal pode estar relacionada a elevações súbitas da pressão intra-abdominal, levando à contração do esfincter and, obstrução das veias subdérmicas do canal anal e à formação de um trombo intravascular

Manifestaçöes perianais nos doentes infectados pelo HIV: comparaçäo com uma populaçäo soronegativa / Perianal disease in HIV - positive patients: comparison with a soronegative population

O objetivo deste trabalho é apresentar nossa casuística, mostrando a prevalência e a natureza das lesöes anorretais em 1.450 doentes HIV positivos e compará-las com os achados mais comuns entre 1.080 soronegativos, atendidos ambulatorialmente, entre janeiro de 89 e dezembro de 95. Dentre os soropositivos, 89,1 por cento eram masculinos e a faixa etária predominante foi a terceira e quarta décadas, sendo que condilomas acuminados, úlceras, hemorróidas, fístulas, fissuras, abscessos e tumores, os achados mais freqüentes. Encontramos doenças perianais associadas em 16,7 por cento dos casos. Nos doentes soronegativos observamos mesma incidência entre os sexos e a faixa etária predominante foram as quarta e quinta décadas e as hemorróidas, fístulas, plicomas e fissuras foram diagnósticos mais comuns. A análise dos dados obtidos no presente trabalho nos permitiu concluir que os soropositivos apresentam maior incidência de condilomas, úlceras, neoplasias, fístulas e abscessos do que a populaçäo soronegativa, que tem maior freqüencia de hemorróidas. A incidência de fissuras foi semelhante em ambos os grupos

SIDA en proctología / AIDS in proctology

Un equipo multidisciplinario ha tratado 257 pacientes de riesgo de infección por HIV en los últimos 6 años. El número de estos pacientes se ha incrementado anualmente y duplicado en el último año. El 86 por ciento pertenece al sexo masculino y la edad promedio es de 30,3 años. El grupo más numeroso esta constituido por varones homosexuales (164 pacientes, 64 por ciento ) en orden de frecuencia siguen los heterosexuales drogadictos (65 pacientes, 35 por ciento ) y los hemofílicos (28 pacientes, 11 por ciento ). Las úlceras anales y rectales constituyen la patología proctológica hallada con mayor frecuencia (105 pacientes, 41 por ciento ) siguen los condilomas acuminados (73 pacientes, 28 por ciento ) y las proctitis y proctocolitis (51 pacientes, 19 por ciento ). En los períodos avanzados de la enfermedad la patología anal es múltiple. La piel perianal esta húmeda, enrojecida por la micosis, el ano congestivo con exudado purupento, plicomas turgentes, condilomas y úlceras. Es aconsejable insistir en el tratamiento médico específico o sintomático de la patología proctológica que obtiene notables remisiones y mejora la calidad de vida y reservar la cirugía, atemperada en cuanto a la magnitud de las incisiones, para los procesos agudos y la cirugía electiva indispensable

Patología anorrectal en pacientes de alto riesgo de infección por HIV / Anorectal pathology in HIV patients

Se estudiaron 208 pacientes de alto riesgo de infección por HIV en cinco años y medio. Se definieron los factores de riesgo y de analizaron los estudios realizados. Se describieron las lesiones encontradas, los tratamientos efectuados y los resultados obtenidos