Profile of Crohn's disease patients who underwent anorectal examination under anesthesia

Introduction: Crohn's disease (CD) is an inflammatory bowel disease, and in ~ 30% of cases it is associated with perianalmanifestations. To identify the extent of the damage and to implement an appropriate treatment, anorectal examination under anesthesia (EUA) is fundamental. Objective: To describe the profile of patients who underwent anorectal EUA in university and private hospitals in the state of Bahia, Brazil. Methodology: A retrospective, descriptive study with 46 patients who underwent anorectal EUA between March, 2016 and November, 2019. Results: A total of 62 anorectal EUAs were performed in 46 patients. With an average age of 36.8 years, the female gender was predominant (52.2%) among these patients. Anal fistulas were the most frequent findings (83.8%), and in most cases they were treated with a seton placement (69.4%). The main recommended surgical indication was a proper evaluation and identification of perianal disease, followed by drainage of the abscess and therefore immunobiological therapy (59.6%). Conclusion: In the present study, the profile of CD patients was similar to those found in the literature, with a high rate of complex anal fistulas. Additional studies are still necessary to further comprehend and treat this particular and debilitating manifestation of the disease. (AU)

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.

Características manométricas en niños con estreñimiento crónico y patología anorrectal adquirida / Manometric characteristics in children with chronic constipation and acquired anorectal pathology

Objetivos: Describir los resultados de las manometrías anorrectales (MAR) en pacientes pediátricos con estreñimiento crónico y patología anorrectal adquirida. Materiales y métodos: Se revisaron los expedientes de pacientes pediátricos referidos entre 2004 y 2016 al Laboratorio de Motilidad Gastrointestinal del Hospital San José Tec de Monterrey para evaluación por manometría anorrectal y que presentaron patología anorrectal adquirida. Resultados: Se revisaron 170 expedientes. Edad 7,18 ± 4,51 años. La prevalencia de patología anorrectal (PA) fue de 73%. Síntomas con mayor incidencia: dificultad para evacuar (78%), dolor al evacuar (67%), heces duras (50%) e incontinencia fecal asociado (49%). El 44% de los pacientes con esfínter anal externo (EAE) hipotónico presentaron incontinencia y 74% estos últimos, presentaron menor volumen máximo tolerable (VMT). Los valores manométricos con mayor significancia: presión en reposo del EAE (promedio ± DE) 14,16 ± 10,19 en PA y de 26,08 ± 13,65 en SPA; presión en contracción del EAE 48,4 ± 34,1 en PA y 68,3 ± 37,7 en SPA; VMT 120,8 ± 60,4 en PA y de 173,2 ± 78,0 en SPA. El 97,97% de los pacientes en los que se evaluó la coordinación abdomino-pélvica tuvieron disinergia del piso pélvico. Conclusiones: A diferencia de la población adulta, los valores manométricos de niños con patología anorrectal se encontraron dentro de rangos normales excepto por el EAE y el VMT los cuales estuvieron disminuidos. Esto puede sugerir un mecanismo diferente en la población pediátrica. La disinergia del piso pélvico podría explicar el estreñimiento crónico en estos pacientes.

Objective: To describe the anorectal manometry results in the pediatric population with chronic constipation and acquired anorectal disease. Materials and methods: We reviewed the records of children who were referred to the Motility and Pelvic Floor Laboratory of the Hospital San Jose Tecnologico de Monterrey between 2004-2016 for further evaluation with anorectal manometry and who presented acquired anorectal disease. Results: We reviewed 170 records. The mean age was 7.18 ± 4.51 years old. The prevalence of anorectal disease was 73%. The symptoms more frequently presented were difficult evacuation (78%), painful defecation (67%), large and hard stool (50%) and fecal soiling (49%). 44% of patients with hypotonic external anal sphincter (EAS) presented with soiling and 74% of those had diminished critical volume. Significant manometric values (p<0.05) were EAS resting pressure, maximal squeeze pressure, and critical volume. 97.7% of those who underwent abdomino pelvic coordination evaluation had pelvic floor dyssynergia (anismus). Conclusions: Contrary to adult population, the manometric values in children with acquire anorectal pathology were within normal values except for the EAS resting pressure and critical volume that were diminished. This could suggest a different mechanism in the pediatric population. Pelvic floor dyssynergia could explain chronic constipation in these patients.

Intervenciones de enfermería en pacientes con cirugía ambulatoria de enfermedades anorectales / Nursing interventions in patients with anorectal diseases outpatient surgery

RESUMEN Introducción: En la cirugía ambulatoria, el paciente es operado y enviado el mismo día a su hogar, es decir, requiere poco tiempo de estadía hospitalaria después del procedimiento. Una unidad de cirugía ambulatoria en coloproctología precisa, además de cirujanos coloproctólogos expertos, de una atención de enfermería de calidad, con amplio conocimiento de las principales intervenciones que se deben realizar a los pacientes. Objetivo: Sistematizar las principales intervenciones de enfermería en pacientes con cirugía ambulatoria de enfermedades anorectales. Métodos: Revisión bibliográfica sistemática para realizar análisis crítico reflexivo del contenido artículos originales y de revisión publicados entre 1997 y 2015 en español portugués e inglés. La búsqueda fue realizada en las bases de datos Medline y SciELO de enero a marzo de 2016, las palabras clave utilizadas fueron "cirugía ambulatoria", "intervenciones de enfermería". Tras la identificación de los estudios pre-seleccionados se llevó a cabo la lectura de los títulos, resumen y palabras clave, comprobando la pertinencia con el estudio. Conclusiones: Se potencializa la responsabilidad profesional implícita en el acto del cuidado y se adquiere conocimiento de las enfermedades anorectales más frecuentes, para realizar con calidad y seguridad las intervenciones de enfermería(AU)

ABSTRACT Introduction: Outpatient surgery the patient is operated on the same day and sent home, ie, requires little time of hospital stay after the procedure. An ambulatory surgery unit in coloproctology accurate, as well as experts colorectal surgeons, a nursing care quality, with extensive knowledge of the main interventions to be performed by patients. Objective: To systematize the main nursing interventions in patients with anorectal diseases outpatient surgery. Methods: Systematic literature review for thoughtful critical analysis of original content and review articles published between 1997 and 2015 in Portuguese and English Spanish. The search was conducted in Medline and SciELO bases January to March 2016 data, the keywords used were "ambulatory surgery", "nursing interventions". Following the identification of pre-selected studies he carried out reading the titles, abstract and keywords, checking the relevance to the study. Conclusions: It potentiates professional liability implicit in the act of care and knowledge of the most common anorectal disease is acquired, for quality and safety of nursing interventions(AU)

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).

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.

Lesões anorretais em pacientes HIV positivos usuários de terapia anti-retroviral de alta efetividade / Anorrectal lesions in HIV-positive patients using highly active antiretroviral therapy

As lesões anorretais são comuns nos pacientes positivos para o vírus da imunodeficiência humana. A terapia antirretroviral de alta efetividade tem pouca influência na progressão das neoplasias anais. Estudou-se a prevalência das lesões anorretais em 88 pacientes HIV positivos atendidos no serviço de doenças infecto-parasitárias do Hospital Universitário de Brasília, em uso de terapia antirretroviral de alta efetividade. Dados sócio-demográficos foram coletados usando um questionário pré-elaborado e os pacientes foram submetidos a exame proctológico. Cerca de 71 por cento relataram coito anal e 30,7 por cento estavam em uso de inibidor de protease. A prevalência das lesões anorretais foi 36,4 por cento, sendo as mais freqüentes: condiloma acuminado e fissura anal. O condiloma acuminado foi a lesão anorretal mais prevalente e teve associação com o uso de lopinavir/ritonavir. Sugere-se o rastreamento das lesões anorretais causadas pelo papilomavírus humano nos pacientes HIV positivos/AIDS em uso de inibidor de protease.

Anorectal lesions are common in patients with human immunodeficiency virus (HIV). Highly active anti-retroviral therapy (HAART) has little influence on the progression of anal neoplasms. The prevalence of anorectal lesions in 88 HIV-positive patients attended at the infectious diseases service of the University Hospital of Brasília who were using HAART was studied. Sociodemographic data were collected using a pre-prepared questionnaire and then the patients underwent proctological examination. Around 71 percent of the patients said they practiced anal intercourse. 30.7 percent were using a protease inhibitor. The prevalence of anorectal lesions was 36.4 percent, and condyloma acuminata and anal fissure were the most frequent of these. Condyloma acuminata was the most prevalent anorectal lesion and was strongly associated with the use of lopinavir/ritonavir. Screening for anorectal lesions caused by human papillomavirus in HIV/AIDS patients who use protease inhibitors is suggested.

Demographic and anatomical survey of colorectal polyps in an Iranian population.

OBJECTIVE: Asian countries generally have low incidences of colorectal cancers (CRCs). One approach to prevention is based on recognition and removal of polyps. The aim of this study was to determine basic demographic features, anatomic distribution and characteristics of colorectal polyps in a local Asian population for comparison with western data. METHODS: We here performed a retrospective chart review of 194 patients with colorectal polyps detected by endoscopy [total colonoscopy in 136 cases (73.1%), and flexible sigmoidoscopy in the remainder] during 1992-2005, focusing on descriptive statistics for categorical variables, including distribution pattern and histology. Cold biopsy in 14 cases, piecemeal endoscopic resection in 5 patients, and usual snare polypectomy in the remainder were performed. Patients with polyposis syndromes were excluded from the analysis. RESULTS: The average age of patients was 43.2 yr (range 2-80) with 71% being males. Most of the polyps were presented in 5th decade (p=0.029). A total of 32 (17.2%) had synchronous proximal polyps (15% adenomas), and 154 cases had solitary polyps. The vast majority of the polyps were left sided and the most frequent type was adenoma (63%), with a villous component in 37.1%. Coexistent cancer was seen in 10.9% of cases. CONCLUSION: In this Iranian population, the majority of polyps are left sided. The incidence of adenomas and their histology appear comparable to data for western patients, but with a significantly lower rate for synchronous neoplastic lesions.

Análise da prevalência por sexo e idade nas doenças anorretais frequentes / Analysis of the prevalence for sex and age in the frequent anorectal diseases

Objetivos: Apresentar uma análise da prevalência referente ao sexo e idade das doenças anorretais mais comuns em ambulatório de Coloproctologia. Pacientes e métodos: De um total de 2323 pacientes atendidos em 88 meses foram incluídos 1024 os quais apresentavam doenças anorretais freqüentes (doença hemorroidária, trombose peri-anal, fissura e fístula anal) conforme critérios rígidos e avaliados pelo mesmo examinador. Resultados e Conclusões: As doenças anorretais freqüentes representaram 44por cento dos atendimentos e destes, 59por cento foram pacientes do sexo feminino. Observou-se predominância do sexo masculino para hemoróidas, trombose peri-anal e fístulas/abscessos, enquanto que plicomas e fissuras foram observadas com maior freqüência nas mulheres. A análise de incidência por faixas etárias demonstrou redução gradual com o avanço da idade sugerindo uma etiopatogenia não degenerativa para as doenças analisadas. Estes resultados sugerem a importância do estudo epidemiológico para a compreensão da história natural das doenças anorretais.

Recent studies on Schistosoma intercalatum: taxonomic status, puzzling distribution and transmission foci revisited

Schistosoma intercalatum, which causes human rectal schistosomiasis in Africa, still presents a great interest for its imprecise taxonomic status and its puzzling distribution in Africa. Two geographically isolated strains of S. intercalatum are recognized, the Lower Guinea strain and the Congo strain, which differ from each other in a number of morphological, biological and biochemical characteristics. Recent molecular data using RAPD markers indicate high divergence between the two strains, with values of Nei and Li's similarity indice allowing recognition of two genetically distinct taxa: experiments on pre- and post-isolating mechanisms are in progress in order to re-evaluate the taxonomic status of this polytypic species. With regard to its geographical distribution, S. intercalatum is characterized by the existence of two stable endemic areas (localized in Lower Guinea and North East of Democratic Republic of Congo) which correspond to the historical areas of species discovery, and the emergence during the last 15 years of new foci of the Lower Guinea strain outside previously known endemic areas. The absence of local adaptation of the Lower Guinea strain to its intermediate host, supported by experimental studies, may help to facilitate the spread of this strain. Nevertheless, the present restricted distribution of this species remains puzzling, because its potential snail hosts (bulinids) are widely distributed throughout much of Africa. Recent experimental and epidemiological studies suggest that interspecific sexual interactions between human schistosomes could have a role in limiting the distribution of S. intercalatum: the competitive sexual processes acting among human schistosomes show that S. haematobium and S. mansoni are always competitively dominant over S. intercalatum. These epidemiological observations lead the authors to distinguish three kinds of transmission foci for S. intercalatum

Significance of rectosigmoid polyp as a predictor of proximal colonic polyp

The association between rectosigmoid polyps and polyps in the more proximal colon is still a matter of debate, and the need for colonoscopy in patients with rectosigmoid polyps that are detected by flexible sigmoidoscopy is controversial. The aim of this study was to determine whether or not certain characteristics of rectosigmoid polyps are associated with the presence and characteristics of proximal colonic polyps. Seven hundred and twenty-eight patients who underwent total colonoscopy between October 1995 and June 1998 and who had colorectal polyps were retrospectively analyzed. Patients with inflammatory bowel diseases, familial adenomatous polyposis, or any advanced cancer were excluded. The odds ratio (OR) and 95% confidence interval (CI) of prevalence of proximal colonic polyps according to the patients age and sex, as well as the characteristics of rectosigmoid polyps, were calculated. Advanced adenoma was defined as an adenoma larger than 10 mm or an adenoma of any size with villous component, high-grade dysplasia or invasive carcinoma. Among 728 patients with colorectal polyps, 356 patients (48.9%) had polyps only in the rectosigmoid region, 193 patients (26.5%) had polyps only in the proximal colon, and 179 patients (24.6%) had polyps in both the rectosigmoid and proximal colon. In 535 patients with rectosigmoid polyps, the prevalence of proximal colonic polyps, neoplastic polyps and advanced adenomas were 33.4%, 27.3% and 2.9%, respectively. The prevalence of proximal colonic polyps in patients with rectosigmoid polyps was found to be significantly related to the male gender and elderly patients, in addition to the neoplastic histology of the rectosigmoid polyps. However, the prevalence of the proximal colonic polyps was not related to the size, number and shape of rectosigmoid polyps. In 179 patients with both rectosigmoid and proximal colonic polyps, the characteristics of proximal colonic polyps such as size, number and shape were similar to those of rectosigmoid polyps. We recommend total colonoscopic examination in all patients with rectosigmoid adenomas, regardless of the size, number, and shape, especially in elderly males.

Sangrado rectal en pediatría: protocolo de manejo / Rectal bleeding in pediatrics: management protocol

Objetivo: Analizar la funcionalidad y utilidad de un protocolo para el manejo de niños con sangrado rectal que se adapte a nuestras condiciones de trabajo, con sus limitaciones y características. Se priorizan los pasos para lograr: a) la supervivencia del niño, b)excluir condiciones quirúrgicas que requieran tratamiento de urgencia y c) establecer un diagnóstico etiológico. Diseño. Estudio clínico, descriptivo. Población. 258 niños de ambos sexos, entre 0-12 años de edad..Metodología. Elaboración de un protocolo y su aplicación en el ejercicio diagnóstico realizado en el grupo.Los pacientes fueron incluídos en el orden que consultaron, sin un proceso de selección especial, excepto el motivo de consulta. Se analizó la evolución clínica de los niños en base al protocolo.Resultados.Doscientos cincuenta y ocho niños, 56/100 varones. Media et rea: 5 años 4 meses. El 9/100 (23 niños) se presentaron con inestabilidad hemodin mica(varices esof gicas, divertículo de Meckel y otros); 14 pacientes (6/100)requirieron cirugía de urgencia. Se ejecutaron 518 procedimientos, siendo los m s frecuentes proctosigmoidoscopía rígida y radiología de contraste. Las causas m s frecuentes de sangrado fueron pólipo rectal (26.7/100), colitis parasitaria (15.5/100) y úlcera péptica (13.2/100). No pudo establecerse diagnóstico específico en 10 niños.Conclusiones. El protocolo propuesto es eficaz y se adapta a las condiciones de trabajo de nuestra pr ctica diaria, adem s permite seleccionar los casos que requieren terapia de reanimación y/o cirugía de urgencia

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

Estudo retrospectivo de 870 exames proctológicos em pacientes de área metropolitana / Retrospective study of 870 proctologic examinations in patients of metropolitan area

Os autores revêem, retrospectivamente, 870 exames proctológicos realizados por um deles, como coloproctologista único de um hospital de referência em área metropolitana de Belo Horizonte, no decurso de quatro anos, em pacientes ambulatoriais (616 pacientes, 78,80 por cento) e internados (254 pacientes, 29,20 por cento), analisando fatores identificadores (idade, sexo, raça, alfabetizaçäo e níveis de escolaridade e instruçäo), resoluçäo do exame proctológico, diagnósticos proctológicos, diagnósticos definitivos e tratamentos instituídos. Verificam um baixo nível etário (519 pacientes ou 60 por cento com idades inferiores a 40 anos), semelhança de incidência por sexos (468 homens, 53,79 por cento e 412 mulheres, 46,21 por cento). No tocante à escolaridade, nota-se uma elevadíssima incidência de indivíduos analfabetos (223 pacientes, 25,63 por cento), que com os alfabetizados totalizam 650 pacientes (74,72 por cento) com baixos níveis de informaçäo e cultura. Chamam a atençäo para o elevado teor de resoluçäo do exame proctológico, que atingiu 624 (77,93 por cento) diagnósticos positivos e 192 (22,0 por cento) diagnósticos normais, totalizando 747 (85,86 por cento) resoluçöes na primeira consulta, e para os principais diagnósticos definitivos dos pacientes: parasitoses intestinais (452 casos, 51,95 por cento), hemorróida (367 casos, 42,18 por cento) e fissuras anais (136 casos, 15,63 por cento). Deixando-se de lado as parasitoses intestinais foram as seguintes as abordagens terapêuticas: tratamentos clínicos foram realizados em 348 pacientes, 40,00 por cento (além dos 452 casos de parasitoses intestinais), tratamentos cirúrgicos em 274 casos (31,50 por cento) e sem tratamento ou tratamentos sintomáticos 234 casos (26,90 por cento)

Polipectomía colonoscópica pediátrica / Pediatric colonoscopy polipectomy

Los pólipos rectocolónicos son relativamente frecuentes en la infancia y constituyen una de las mayores causas de sangrado rectal. La polipectomía endoscópica, por su baja morbilidad y mortalidad, ha revolucionado su tratamiento. Entre el 1º de octubre de 1985 y el 31 de mayo de 1994, se resecó por endoscopía, 122 pólipos rectocolónicos, en 88 pacientes pediátricos. Cuarenticinco (51.1 por ciento) de los pacientes fueron hombres y 43 (48.9 por ciento) fueron mujeres. Entre 1 y 5 años se encontro el mayor número de pacientes, correspondieron a 44 casos (50 por ciento). La localización más frecuente fué el recto en 95 (77.9 por ciento). Respecto a tamaño, 63 de los pólipos (51.6 por ciento) midieron entre 1 y 2 cm, diámetro mayor. Sesentitrés pacientes (83 por ciento tuvieron pólipo único, 10 (11.4 por ciento) tuvieron dobles y en 1 paciente se encontró 12 pólipos. Noventiseis (78.7 por ciento) fueron pediculados, siendo ésta la forma más frecuente. Histológicamente el más común fué el pólipo juvenil en 106 casos (87.6 por ciento). Las polipectomías fueron hechas sin uso de anestesia general y en forma ambulatoria. No tuvimos ninguna complicación en el procedimiento. Se concluye que la polipectomía colonoscópica es un método útil, sencillo y seguro para el tratamiento de pólipos rectocolónicos en niños

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