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J. coloproctol. (Rio J., Impr.) ; 41(4): 348-354, Out.-Dec. 2021. tab, ilus
Article in English | LILACS | ID: biblio-1356439


Background: In transanalminimally-invasive surgery (TAMIS), the closure of the rectal defect is controversial, and endoluminal suture is one of the most challenging aspects. The goal of the present study is to evaluate the short- andmedium-term complications of a consecutive series of patients with extraperitoneal rectal injuries who underwent TAMIS without closure of the rectal defect. Materials and Methods: A prospective, longitudinal, descriptive study conducted between August 2013 and July 2019 in which all patients with extraperitoneal rectal lesions, who were operated on using the TAMIS technique, were consecutively included. The lesions were: benign lesions ≥ 3 cm; neuroendocrine tumors ≤ 2 cm; adenocarcinomas in stage T1N0; and adenocarcinomas in stage T2N0, with high surgical risk, or with the patients reluctant to undergo radical surgery, and others with doubts about complete remission after the neoadjuvant therapy. Bleeding, infectious complications, rectal stenosis, perforations, and death were evaluated. Results: A total of 35 patients were treated using TAMIS without closure of the defect. The average size of the lesionswas of 3.68±2.1 cm(95% confidence interval [95%CI]: 0.7cmto 9 cm), their average distance from the anal margin was of 5.7±1.48cm, and the average operative time was of 39.2±20.5 minutes, with a minimum postoperative follow-up of 1 year. As for the pathologies, they were: 15 adenomas; 3 carcinoid tumors; and 17 adenocarcinomas. In all cases, the rectal defect was left open. The overall morbidity was of 14.2%. Two patients (grade II in the Clavien-Dindo classification) were readmitted for pain treatment, and three patients (grade III in the Clavien-Dindo classification) were assisted due to postoperative bleeding, one of whom required reoperation. Conclusion: The TAMIS technique without closure of the rectal defect yields good results, and present a high feasibility and low complication rate. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Anal Canal/surgery , Transanal Endoscopic Surgery , Anal Canal/injuries
Prensa méd. argent ; 107(6): 312-317, 20210000. tab, fig
Article in English | LILACS, BINACIS | ID: biblio-1359107


Antecedentes: la fístula de ano es un problema crónico para los pacientes. Causa angustia debido al mal olor y la suciedad con infecciones y secreciones recurrentes. La recurrencia y la lesión del esfínter anal fueron las complicaciones más críticas después de la cirugía. La colocación de un setón suelto y grueso fue la operación quirúrgica más prometedora. Reducir el tiempo de colocación del setón para disminuir el sufrimiento de los pacientes por la suciedad y múltiples apósitos. Pacientes y métodos: estudio retrospectivo. Cien pacientes con fístula anal alta tratados quirúrgicamente en la ciudad médica de Al-Sader y en la clínica privada diaria de Al-Najaf, ciudad de Najaf, Irak, desde febrero de 2018 hasta marzo de 2019. Se han tomado imágenes de fistulografía y resonancia magnética de todos los pacientes. Después de eso, se realiza una fistulectomía con sutura de setón suelta y gruesa durante tres meses. Los pacientes con persistencia del trayecto de trayecto fistuloso fueron sometidos a una segunda cirugía y una tercera operación hasta su completa curación. Resultados: Cien pacientes con fístula de tipo alto en ano con 96 varones (96%) y mujeres 4 (4%). La tasa de curación completa entre los pacientes masculinos después de la primera operación fue de 90 (93%), mientras que las mujeres mostraron una tasa de curación completa de 4 (100%) después de la primera operación. Tres de los pacientes varones restantes con un tracto de fístula alto persistente mostraron una curación completa después de la segunda operación, mientras que en 3 (3%) la tasa de curación completa fue del 100% después de la tercera operación. Conclusión: Un setón suelto y grueso colocado en un tracto de fístula de tipo alto durante tres meses brinda una excelente protección al esfínter anal externo con una tasa de recurrencia menor y una curación rápida.

Background: Fistula in ano is a chronic problem for the patients. It causes distressing because of foul odour and soiling with recurrent infection and discharge. Recurrence and anal sphincter injury were the most critical complications following surgery. Loose, thick seton placement was the most promising surgical operation. To reduce the time of seton placement, therefore, decreasing the suffering of patients from soiling and multiple dressing. Patients and Methods: A retrospective study. One hundred patients with high type fistula in ano treated surgically in Al-Sader Medical city and Al-Najaf daily private clinic, Najaf city, Iraq from Feb 2018 to March 2019. Fistulography and magnetic resonance imaging have taken from all patients. After that, fistulectomy with loose, thick seton suture placed for three months. Patients with the persistence of high fistula tract underwent a second surgery and third operation until complete healing. Results: One hundred patients with high type fistula in ano with male 96 (96%) and female patients were 4 (4%). The rate of complete healing among male patients after the first operation was 90 (93%), while female patients showed a 4(100%) rate of complete healing after the first operation. Three of the remaining male patients with persistently high fistula tract showed complete healing after the second operation, whereas 3 (3%) the rate of complete healing was 100% after the third operation. Conclusion: A Loose, thick seton placed in high type fistula tract for three months provides excellent protection to the external anal sphincter with less recurrence rate and rapid healing

Humans , Anal Canal/injuries , Recurrence , Reoperation/methods , Sutures , Retrospective Studies , Rectal Fistula/surgery , Rectal Fistula/therapy
J. coloproctol. (Rio J., Impr.) ; 41(3): 222-227, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1346422


Introduction: Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal canal associated with HPV, with a higher prevalence in immunosuppressed individuals. Patients with inflammatory bowel disease (IBD) are at potential risk for their development, due to the use of immunosuppressants and certain characteristics of the disease. Method: This is a prospective, cross-sectional, and interventional study that included 53 patients with IBD treated at a tertiary outpatient clinic, who underwent anal smear for cytology in order to assess the prevalence of AIN and associated risk factors. Results: Forty-eight samples were negative for dysplasia and 2 were positive (4%). Both positive samples occurred in women, with Crohn's disease (CD), who were immunosuppressed and had a history of receptive anal intercourse. Discussion: The prevalence of anal dysplasia in IBD patients in this study is similar to that described in low-risk populations. Literature data are scarce and conflicting and there is no evidence to recommend screening with routine anal cytology in patients with IBD. Female gender, history of receptive anal intercourse, immunosuppression and CD seem to be risk factors. (AU)

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Anal Canal/injuries , Anus Neoplasms/epidemiology , Inflammatory Bowel Diseases , Anal Canal/cytology , Crohn Disease
J. coloproctol. (Rio J., Impr.) ; 41(1): 30-36, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1286963


Abstract Objective Several techniques are used to repair the anal sphincter following injury. The aim of the present study is to comprehensively analyze the short- and long-term outcomes of overlap repair following anal sphincter injury. Methods A search was conducted in the PubMed, Medline, Embase, Scopus and Google Scholar databases between January 2000 and January 2020. Studies that described the outcomes that are specific to overlap sphincter repair for fecal incontinence with a minimum follow-up period of one year were selected. Results A total of 22 studies described the outcomes of overlap sphincter repair. However, 14 studies included other surgical techniques in addition to overlap repair, and were excluded from the analysis. Finally, data from 8 studies including 429 repairs were analyzed. All studies used at least one objective instrument; however, there was significant heterogeneity among them. Most patients were female (n=407; 94.87%) and the mean age of the included individuals was 44.6 years. The majority of the procedures were performed due to obstetric injuries (n=384; 89.51%). The eight included studies described long-term outcomes, and seven of them demonstrated statistically significant improvements regarding the continence; one study described poor outcomes in terms of overall continence. The long-term scores were significantly better compared with the preoperative scores. However, compared with the shortterm scores, a statistically significant deterioration was noted in the long-term. Conclusion The majority of the studies described good long-term outcomes in terms of anal continence after overlap sphincter repair. However, further studies are needed

Resumo Objetivo Diversas técnicas são usadas no reparo do esfíncter anal após lesões. O objetivo deste estudo é fazer uma análise completa dos desfechos nos curto e longo prazos do reparo por sobreposição após lesão do esfíncter anal. Métodos Realizou-se uma busca nas bases de dados PubMed, Medline, Embase, Scopus e Google Scholar entre janeiro de 2000 e janeiro de 2020. Estudos que descreviam desfechos específicos do reparo de esfíncter por sobreposição para incontinência fecal, com um mínimo de 1 ano de seguimento, foram selecionados. Resultados No total, 22 estudos descreviam os desfechos do reparo de esfíncter por sobreposição. No entanto, 14 estudos incluíam outras técnicas cirúrgicas além do reparo por sobreposição, e foram excluídos da análise. Por fim, dados de 8 estudos que incluíam 429 reparos foram analisados. Todos os estudos usaram pelo menos um instrumento objetivo, mas havia uma heterogeneidade significativa entre eles. A maioria dos pacientes era do sexo feminino (n=407; 94,87%), e a idade média dos indivíduos incluídos foi de 44,6 anos. A maioria das cirurgias foi realizada devido a lesões obstétricas (n=384; 89,51%). Os oito estudos incluídos descreveram os desfechos no longo prazo, e sete deles demonstraram melhoras estatisticamente significativas com relação à continência; um estudo descreveu resultados ruins em termos gerais com relação à continência. As pontuações no longo prazo foram significativamente melhores em comparação com as pontuações no pré-operatório. No entanto, em comparação com as pontuações no curto prazo, percebeu-se uma piora estatisticamente significativa no longo prazo. Conclusão A maioria dos estudos descrevia bons resultados no longo prazo em termos de continência anal depois do reparo do esfíncter por sobreposição. Entretanto mais estudos são necessários para que se identifiquem os fatores associados aos desfechos ruins para auxiliar na seleção de pacientes para o reparo por sobreposição.

Humans , Male , Female , Anal Canal/surgery , Anal Canal/injuries , Rectal Diseases/surgery , Fecal Incontinence/etiology
Rev. argent. coloproctología ; 30(2): 51-56, Jun. 2019. tab
Article in Spanish | LILACS | ID: biblio-1025473


Introducción: La incontinencia anal es una compleja y devastadora patología que altera la calidad de vida de los pacientes, cuya etiología más común es la lesión esfintérica postparto vaginal. A la hora de clasificar la incontinencia, el score descripto por Jorge y Wexner es el más utilizado en nuestro medio. La ecografía endoanal ha sido definida como el gold standard para evaluar los defectos del esfínter anal. Objetivo: Determinar la correlación entre los hallazgos clínicos y ecográficos en pacientes con incontinencia fecal de causa obstétrica. Material y Métodos: Población: pacientes que consultaron en el Centro Privado de Cirugía y Coloproctología entre enero de 2015 y diciembre de 2017 por incontinencia fecal con antecedentes de trauma obstétrico y a las que se les realizó una ecografía endoanal 360° y score de Jorge y Wexner. Resultados: Se evaluaron 24 pacientes. La media de edad fue de 56 años. El número de partos en promedio fue 2,3 y el Score de Wexner en promedio fue 9.7 (±5.2). La ecografía endoanal confirmó alteración esfintérica por afinamiento o interrupción en el 100% de los pacientes. Se observó una tendencia a una asociación negativa entre el Score de Wexner y la ecografía endoanal (r=-0.328, p=0.067). Las pacientes con menor grado de lesión esfinteriana por ecografía tenían mayor severidad en el Score de Wexner que las pacientes con mayor grado de lesión. Las pacientes con evidencia ecográfica de lesiones leves refirieron un mayor Score de Wexner que aquellas con lesiones severas. Conclusión: En este trabajo no existió correlación entre los hallazgos ecográficos y el score de incontinencia. Si bien la ecografía esfintérica es el gold standard para evaluar daño muscular, la terapéutica no debe ser determinada solamente por la ecografía. Tipo de estudio: Retrospectivo, transversal y descriptivo.

Introduction: Anal incontinence is a complex and devastating pathology that alters the patient's quality of life, whose most common etiology is vaginal postpartum sphincter injury. To classify incontinence, the score described by Jorge and Wexner is the most used in our environment. Endoanal ultrasound has been defined as the gold standard for evaluating anal sphincter defects. Objective: To determine the correlation between clinical and ultrasound findings in patients with fecal incontinence due to obstetric cause. Material and Methods: Population: patients who consulted at the Private Center of Surgery and Coloproctology between January 2015 and December 2017 due to fecal incontinence with a history of obstetric trauma and who underwent a 360º endoanal ultrasound and a Jorge and Wexner score. Results: Twenty-four patients were evaluated. The average age was 56 years. The number of births on average was 2.3 and the Wexner Score on average was 9.7 (± 5.2). Endoanal ultrasound confirmed sphincter alteration by refining or interruption in 100% of patients. A tendency to a negative association was observed between the Wexner Score and the endoanal ultrasound (r = -0.328, p = 0.067). Patients with a lower degree of sphincter injury by ultrasound had greater severity in the Wexner Score than patients with a higher degree of injury. Patients with ultrasound evidence of mild lesions reported a higher Wexner Score than those with severe lesions. Conclusion: In this work, there was no correlation between the sonographic findings and the incontinence score. Although sphincter ultrasonography is the gold standard for assessing muscle damage, therapy should not be determined only by ultrasound. Type of study: Retrospective, cross-sectional and descriptive.

Humans , Female , Pregnancy , Adult , Middle Aged , Aged , Aged, 80 and over , Anal Canal/injuries , Anal Canal/diagnostic imaging , Endosonography/methods , Fecal Incontinence/etiology , Risk Factors , Fecal Incontinence/diagnostic imaging , Obstetric Labor Complications
Rev. bras. ginecol. obstet ; 40(8): 465-470, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-959024


Abstract Objective To describe and evaluate the use of a simple, low-cost, and reproducible simulator for teaching the repair of obstetric anal sphincter injuries (OASIS). Methods Twenty resident doctors in obstetrics and gynecology and four obstetricians participated in the simulation. A fourth-degree tear model was created using lowcost materials (condom simulating the rectal mucosa, cotton tissue simulating the internal anal sphincter, and bovine meat simulating the external anal sphincter). The simulator was initially assembled with the aid of anatomical photos to study the anatomy and meaning of each component of the model. The laceration was created and repaired, using end-to-end or overlapping application techniques. Results The model cost less than R$ 10.00 and was assembled without difficulty, which improved the knowledge of the participants of anatomy and physiology. The sutures of the layers (rectal mucosa, internal sphincter, and external sphincter) were performed in keeping with the surgical technique. All participants were satisfied with the simulation and felt it improved their knowledge and skills. Between 3 and 6 months after the training, 7 participants witnessed severe lacerations in their practice and reported that the simulation was useful for surgical correction. Conclusion The use of a simulator for repair training in OASIS is affordable (low-cost and easy to perform). The simulation seems to improve the knowledge and surgical skills necessary to repair severe lacerations. Further systematized studies should be performed for evaluation.

Resumo Objetivo Descrever e avaliar a utilização de um simulador simples, de baixo custo e reprodutível para o ensino de sutura de lacerações perineais de 4° grau. Métodos Participaram da simulação 20 residentes de ginecologia e obstetrícia e quatro profissionais especialistas. Um modelo de laceração de 4° grau foi criado com materiais de baixo custo (preservativo simulando a mucosa retal, tecido de algodão simulando o esfíncter anal interno e carne bovina simulando o esfíncter anal externo). O simulador foi inicialmente montado com ajuda de fotos anatômicas, para estudar a anatomia e o significado de cada componente do modelo. A laceração foi criada e suturada, utilizando técnicas de borda a borda e de sobreposição do esfíncter anal. Resultados O modelo custou menos de R$ 10,00 e foi montado sem dificuldade, aprimorando os conhecimentos dos participantes sobre anatomia e fisiologia. As suturas das camadas (mucosa retal, esfíncter interno e esfíncter externo) foram realizadas seguindo a técnica cirúrgica. Todos os participantes ficaram satisfeitos coma simulação e consideraram que estamelhorou seus conhecimentos e habilidades. Entre 3 a 6 meses após o treinamento, 7 participantes presenciaram em sua prática lacerações graves e relataram que a simulação foi útil para a correção cirúrgica. Conclusão A utilização de um simulador para treinamento de sutura de lacerações obstétricas graves é acessível (baixo custo e fácil execução). A simulação parece aprimorar conhecimentos e habilidades cirúrgicas para sutura de lacerações graves. Mais estudos sistematizados devem ser realizados para avaliação.

Humans , Female , Pregnancy , Anal Canal/surgery , Anal Canal/injuries , Obstetric Surgical Procedures/education , Suture Techniques/education , Costs and Cost Analysis , Lacerations/surgery , Simulation Training/economics , Gynecology/education , Obstetric Labor Complications/surgery , Obstetrics/education , Self Report , Models, Anatomic
Rev. bras. cir. plást ; 33(1): 135-138, jan.-mar. 2018. ilus
Article in English, Portuguese | LILACS | ID: biblio-883650


Introdução: O câncer anal é uma doença rara, cuja incidência está aumentando. Os retalhos são opções complexas de fechamento quando abrangem grandes áreas. A região perineal pode ser acometida por extensas lesões, requerendo utilização de retalhos. Relato de Caso: Paciente feminina, 56 anos, diagnosticada com adenocarcinoma anal, foi submetida à cirurgia de amputação abdominoperineal do reto associada à radioterapia pós-operatória há 2 anos. Apresentou recidiva cutânea da lesão neoplásica, com indicação de ampliação de margem cirúrgica para controle da recidiva. Após ampla ressecção com margem de segurança o defeito cutâneo, optou-se por duplo retalho em V-Y com 15 cm de comprimento cada e espessura total do tecido celular subcutâneo (TCS) de região glútea para preenchimento do espaço morto deixado pela ressecção e avanço sobre o defeito. Implementou-se antibioticoprofilaxia endovenosa e profilaxia para trombose venosa profunda. Paciente evoluiu bem do procedimento sem intercorrências. Discussão: Retalho é um tecido que é mobilizado conforme sua anatomia vascular. Retalhos baseados no plexo subdérmico incluem os bipediculados, de avanço (V-Y), retalhos de rotação e transposição. Reconstruções de períneo são indicadas devido a tumores, traumas, infecções, queimaduras ou úlceras de pressão. A região anal é dividida em canal anal e margem anal. Dentre os tipos histológicos de neoplasia na região do canal anal, podem ser citados: carcinoma de células escamosas (histologia mais comum), adenocarcinoma, melanoma, carcinoma de pequenas células e sarcomas. O risco de recidiva locorregional, após tratamento, pode atingir cerca de 30% dos casos e é o padrão de recidiva mais frequente.

Introduction: Anal cancer is a rare disease, with an increasing incidence. Flaps are complex options for closing large areas. The perineal region may be affected by extensive lesions that require the use of flaps for repair. Case Report: A 56-year-old female patient with anal adenocarcinoma underwent abdominoperineal amputation surgery of the rectum with postoperative radiotherapy for 2 years. She had cutaneous recurrence of the neoplastic lesion with indication of surgical margin expansion to control the local recurrence. After extensive resection with safety margins of the skin defect, we selected double V-Y flap of length 15 cm each and a total thickness of the gluteal subcutaneous tissue (ST) to fill up the dead space caused by resection and advancement of the defect. Intravenous antibiotic prophylaxis and deep venous thrombosis prophylaxis were administered. The patient progressed well from the procedure, with no problems. Discussion: A flap is a tissue that is mobilized based on vascular anatomy. Flaps based on the subdermal plexus include bipedicle, advancement (V-Y), rotation, and transposition flaps. Perineum reconstructions are often indicated for tumors, trauma, infections, burns, or pressure sores. The anal region is divided into the anal canal and the anal margin. Among the histological types of anal cancer, the most prevalent are squamous cell carcinoma (most common histology), adenocarcinoma, melanoma, small cell carcinoma, and sarcomas. The risk of regional recurrence after treatment can reach approximately 30% of cases and is the most frequent recurrence pattern.

Humans , Female , Middle Aged , History, 21st Century , Anal Canal , Anus Neoplasms , Adenocarcinoma , Reconstructive Surgical Procedures , Perforator Flap , Anal Canal/anatomy & histology , Anal Canal/surgery , Anal Canal/injuries , Anus Neoplasms/surgery , Anus Neoplasms/therapy , Adenocarcinoma/surgery , Reconstructive Surgical Procedures/methods , Perforator Flap/surgery , Perforator Flap/standards
S. Afr. j. surg. (Online) ; 56(2): 23-28, 2018. tab
Article in English | AIM, AIM | ID: biblio-1271011


Background: Occult anal sphincter disruption, following childbirth may contribute to the development of anal incontinence (AI). The type and mechanism of injury may differ between first and subsequent deliveries. Objectives: To describe the effect of pregnancy and delivery on the endosonographic morphology of the anal sphincter and on anal sphincter pressures, and to highlight any differences in these between nulliparous and multiparous Black African and Indian women. Methods: One hundred Black African and Indian women delivering at two hospitals in the Pietermaritzburg area underwent anal endosonography and manometry in the third trimester of pregnancy and 24 hours post-delivery. Those with occult injury were followed up at 6 weeks and six months. Participants were asked about bowel symptoms at each visit. Ante-natal and intra-partum obstetric data was also recorded. Results: The majority were Black African (82%), and 76% were multiparous. Symptoms of urgency increased from 9% antenatally to 14.6% post-delivery, decreasing to 8.3% at six months. Symptoms of AI increased from 10% antenatally to 12.5% post-delivery, falling to 3.1% at six months. Internal sphincter defects were more common among primiparous and multiparous women delivering vaginally. There was a significant drop in functional anal length post-delivery, irrespective of the mode of delivery. Anal pressures also fell post-delivery and at six weeks post-partum. However, by six months there appeared to be a return to pregnancy values.Conclusion: Occult anal sphincter injuries and reduced anal pressures occur after delivery, in the absence of clinically detected anal sphincter trauma, irrespective of the mode of delivery

Anal Canal , Anal Canal/injuries , Pregnant Women , South Africa
J. coloproctol. (Rio J., Impr.) ; 37(3): 225-231, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-893995


Abstract Purpose Anal sphincter injury after delivery is the main factor in the pathogenesis of fecal incontinence. Clinical obvious and specific injury to anal canal sphincter is seen in 3% of vaginal deliveries. There are many women who do not have a clear and specific laceration but they are damaged by sphincter muscles of anal canal. The purpose of the present study is to investigate the frequency of occult anal sphincter injury after vaginal delivery by Endo-anal sonography. Methods Fifty women with first pregnancy were assessed at 27-33 weeks of pregnancy, and at 6 weeks and 6 months after vaginal delivery by questionnaire, examination and Endo-anal sonography. Women age, duration of delivery, the effect of epidural anesthesia, episiotomy and birth weight were studied and Endo-anal sonography results were recorded. Anal manometry was performed for all mothers before delivery and 5 ones with sphincter injury at 6 months and 3 years after delivery. Results Five (10%) patients, with mean age 29.4 ± 6.5 years, mean neonatal weight of 3874 ± 287, and mean duration of delivery 11.6 ± 1.51 h, had signs of sphincter injury in Endo-anal sonography. The injury was persisted at six months after delivery. Also, significant differences were seen between anal manometry before delivery and 6 months and 3 years after delivery (p = 0.006 for mean squeezing pressure) in the five mothers. Conclusion Endo-anal sonography might be a good screening tool for early detection of postpartum anal sphincter damages. However, further prospective cost benefit studies should be performed to propose it as a standard of care.

Resumo Finalidade A lesão de esfíncter anal após o parto é o fator principal na patogênese da incontinência fecal. Observa-se uma lesão clínica óbvia e específica ao esfíncter no canal anal em 3% dos partos vaginais. Em muitas mulheres não se percebe uma laceração nítida e específica, mas houve lesão nos músculos esfinctéricos do canal anal. A finalidade desse estudo é investigar a frequência de lesão oculta de esfíncter no canal anal em seguida ao parto vaginal por meio da ultrassonografia endoanal. Métodos Cinquenta mulheres primíparas foram avaliadas no período de 27-33 semanas de gestação e também a 6 semanas e 6 meses após o parto vaginal por meio de questionário, exame e ultrassonografia endoanal. Foram anotados a idade das pacientes, a duração do parto, o efeito da anestesia epidural, episiotomias e peso do bebê ao nascer; também foram registrados os resultados da ultrassonografia endoanal. Antes do parto, todas as gestantes foram submetidas a um exame de manometria; e 5 mães com lesão esfinctérica também passaram por esse procedimento a 6 meses e 3 anos após o parto. Resultados Cinco (10%) pacientes, com média de idade = 29,4 ± 6,5 anos, peso médio do bebê ao nascer = 3874 ± 287 gramas e duração média do parto = 11,6 ± 1,51 horas, apresentavam sinais de lesão esfinctérica ao exame por ultrassonografia endoanal. Seis meses após o parto, as lesões persistiam. Também foram observadas diferenças significativas entre a manometria anal antes do parto e a 6 meses e 3 anos após o parto (p = 0,006 para média de pressão de contração) nas cinco mães. Conclusão A ultrassonografia endoanal pode ser um bom instrumento de triagem para a detecção precoce de lesões do esfíncter anal no pós-parto. Contudo, é importante que sejam realizados novos estudos prospectivos e de custo-benefício, para que essa técnica possa ser proposta como padrão terapêutico.

Humans , Female , Pregnancy , Adult , Anal Canal/injuries , Endosonography/methods , Delivery, Obstetric/adverse effects
J. coloproctol. (Rio J., Impr.) ; 37(1): 72-79, Jan.-Mar. 2017.
Article in English | LILACS | ID: biblio-841301


ABSTRACT Background: Anal canal carcinoma is a rare neoplasm, representing 2% of the digestive tumors, and the most common is squamous cell carcinoma, with an increasing incidence. Objective: The study aims to elucidate the pathogenesis of an increasingly prevalent disease, as well as to update treatment and prognosis. Methods: A literature search in Pubmed database, including articles from 2005 to 2015 and cross-research articles with the initial research. Results: Several studies prove the role of HPV as a major risk factor in the development of squamous cell carcinoma of anal canal, as well as a greater prevalence of this neoplasia in HIV-positive people and in those who practice receptive anal intercourse. In the last two decades chemoradiotherapy remains the treatment of choice, and abdominoperineal resection is reserved for those cases of treatment failure or recurrence. Evidence advances in order to adapt the treatment to each patient, taking into account individual prognostic factors and biological tumor characteristics. Conclusions: Squamous cell carcinoma of the anal canal is a neoplasm associated with HPV; therefore, screening and vaccination programs of male individuals, by way of prevention, should be started. Many studies are needed in order to achieve development in the treatment as well as in the evaluation of the biological characteristics of the tumor.

RESUMO Introdução: O carcinoma do canal anal é uma neoplasia rara, representando 2% dos tumores digestivos, sendo o epidermóide o mais comum com uma incidência crescente. Objetivo: Este estudo pretende elucidar sobre a etiopatogenia desta patologia cada vez mais prevalente, assim como atualizar sobre o tratamento e prognóstico. Métodos: Pesquisa bibliográfica na base de dados Pubmed, incluindo artigos de 2005 a 2015, assim como artigos de pesquisa cruzada com os artigos iniciais. Resultados: Diversos estudos provam o papel do HPV como um fator de risco major no desenvolvimento de carcinoma epidermóide do canal, assim como uma maior prevalência desta neoplasia na população HIV positiva e nos que praticam sexo anal recetivo. O tratamento continua a ser desde há duas décadas a quimioradioterapia, reservando a resseção abdominoperineal para casos de falência do tratamento ou recorrência. A evidência avança no sentido de adequar o tratamento a cada doente, tendo em conta fatores prognósticos individuais e as características biológicas do tumor. Conclusões: O carcinoma epidermóide do canal anal é uma neoplasia associada ao HPV, logo deveria iniciar-se programas de rastreio e vacinar o sexo masculino como prevenção. Muitos estudos são necessários para evoluir no tratamento, assim como na avaliação das características biológicas do tumor.

Humans , Anus Neoplasms/pathology , Papillomaviridae/physiology , Carcinoma, Squamous Cell/etiology , Carcinoma, Squamous Cell/pathology , HIV/physiology , Papillomavirus Infections/complications , Anal Canal/injuries
Rev. cuba. cir ; 55(4): 334-339, oct.-dic. 2016. ilus
Article in Spanish | LILACS | ID: biblio-844832


El trauma anal es considerado de baja frecuencia, teniendo en cuenta que en las estadísticas se incluye asociado al trauma de recto. Se debe tener claro el abordaje quirúrgico pues pueden presentarse secuelas que afectan en una forma muy importante la calidad de vida futura de los pacientes. Se presenta un caso de trauma anal contuso y se muestra el tratamiento de urgencias(AU)

Anal trauma is considered a low frequency trauma because it is associated with rectal trauma in statistical records. The surgical approach should be taken into account because some sequelae affecting in a very important way the future quality of life of patients may occur. A case of blunt anal trauma and the emergency management indicated were presented in this report(AU)

Humans , Male , Adult , Anal Canal/injuries , Anal Canal/surgery , Colostomy/methods , Quality of Life , Wounds and Injuries
Rev. argent. coloproctología ; 26(2): 33-39, jul. 2015. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-973147


Introducción: La incontinencia fecal mayor es un trastorno que modifica significativamente la calidad devida. Un grupo particularmente afectado son las mujeres con antecedentes de trauma obstétrico. Dentrode ellos, los más graves son los de cuarto grado que involucran la totalidad de las capas del tabique rectovaginal, produciendo una comunicación completa entre la luz rectal y la vagina, generando una cloaca. Sibien la incidencia de éstas, es de alrededor del 0,3% de los partos, el efecto que tiene sobre las pacienteses devastador. El único tratamiento efectivo para este tipo de lesiones es la reparación quirúrgica.Objetivo: Evaluar el impacto que presenta la corrección quirúrgica de la cloaca por trauma obstétrico en lacalidad de vida de las afectadas.Material y Métodos: Análisis prospectivo secundario y ampliado de una serie consecutiva de pacientestratadas por desgarro perineal completo tipo cloaca durante el año 2013. Se evaluó la demografía de lamuestra, la paridad de las pacientes, el tiempo medio hasta la consulta desde el último parto, la manometríapre y postoperatoria, la evaluación de incontinencia fecal pre y postoperatorio. Para valorar la severidad dela incontinencia fecal se utilizó el índice CCF-FIS y el índice de severidad de incontinencia fecal (FISI). Parala evaluación de calidad de vida se utilizó la encuesta FIQLS de la Sociedad Americana de Cirujanos delColon y Recto (ASCRS).Resultados: Tres pacientes fueron intervenidas entre enero de 2013 y diciembre de 2013. En el examenfísico, el 100% de las pacientes presentaron una cloaca perineal. El score CCF-FIS preoperatorio fue del16,7 (16 a 18 puntos). El puntaje de FISI pre-operatorio fue de 54,3 (52 a 57). Las tres pacientes refirieronalteraciones en su actividad social y sexual. Se reevaluaron las pacientes al tercer mes de postoperatorio yluego del cierre de la colostomía...

Introduction: The major fecal incontinence is a disorder that significantly change the quality of life. Aparticularly affected group are women with a history of obstetric trauma and presenting demonstrationsimmediately. Among them, the most serious are the fourth degree involving all the layers of the rectovaginalseptum, producing a complete communication between the rectal lumen and vagina, creating a sewer.Although their incidence is about 0.3% of births, the effect on patients is devastating.Objective: To evaluate the impact making the surgical correction of the cloaca by obstetrical trauma in thequality of life of those affected.Material and Methods: Secondary and expanded Prospective analysis of a consecutive series of patientstreated by complete perineal tear type cloaca in 2013. The demographics of the sample was evaluated theparity of the patients, the median time to the query from the last delivery, pre and postoperative manometry,assessment of pre-and postoperative fecal incontinence. To assess the severity of fecal incontinence CCFFISindex and the severity of fecal incontinence (FISI) was used. The FIQLS survey by the American Societyof Colon and Rectal Surgeons (ASCRS) was used for the evaluation of quality of lifeResults: Three patients were operated between January 2013 and December 2013 on physical examination, 100% of patients had a perineal cloaca. The CCF-FIS preoperative score was 16.67 (16-18 points). Thescore FISI pre-surgery was 54.33 (52-57). The three patients reported changes in their social and sexualactivity. Patients at the third month after surgery and after colostomy closure were reassessed...

Female , Humans , Adult , Delivery, Obstetric/adverse effects , Anal Canal/injuries , Anal Canal/surgery , Rectovaginal Fistula/etiology , Rectovaginal Fistula/surgery , Surgical Flaps , Reconstructive Surgical Procedures/methods , Fecal Incontinence/complications , Fecal Incontinence/surgery , Pelvic Floor/injuries , Severity of Illness Index , Quality of Life , Preoperative Care , Postoperative Care
Rev. argent. coloproctología ; 26(2): 45-53, jul. 2015. tab
Article in Spanish | LILACS | ID: biblio-973149


Introducción: El carcinoma anal escamoso (CAE) representa el 2% de todas las neoplasiascolorrectoanales. Afecta a 2/100.000 habitantes por año en la población general. Se incrementa en lospacientes con serología positiva para el virus de la inmunodeficiencia humana (VIH-positivos), 60/100.000habitantes por año y asciende a 92-144/100.000 habitantes por año en los hombres que tienen sexocon hombres (HSH) VIH-positivos. Al igual que en el carcinoma escamoso del cuello uterino, el virus delpapiloma humano (VPH) está implicado en su génesis, y se encuentra presente en el 92% de los casos.El cáncer cervical y anal comparten el mismo origen embriológico, formando la zona de transformación,sitio donde se desarrollan las lesiones intraepiteliales escamosas (SIL) como resultado de la infección ypersistencia del VPH, en especial de los genotipos de alto riesgo que pueden progresar a CAE invasor. Elaumento significativo de CAE en las últimas décadas ha llevado a desarrollar la pesquisa de SIL anal (ASIL)mediante citología (PAP) y anoscopía de alta resolución (AAR) con técnica colposcópica, emulando losprotocolos de detección temprana para prevención el cáncer de cuello uterino.Objetivo: Conocer prevalencia de lesiones precursoras del CAE. Determinar sensibilidad (S), especificidad (E),valor predictivo positivo (VPP) y negativo (VPN) del PAP para la detección de displasias en población de riesgo.Material y Método: Diseño: Prospectivo, transversal, observacional, analítico. Se incluyeron individuos dealto riesgo (VIH-positivos, HSH, individuos con historia de VPH anogenital, mujeres con antecedentes decáncer o neoplasia intraepitelial genital inferior) estudiados en forma consecutiva, entre abril 2012 y febrero2014, en Consultorio de Detección Temprana del Cáncer Ana...

Introduction: Anal squamous cell carcinoma (SCC) represents 2% of all colo-recto-anal malignancies. It is confirmed a higher rate of anal cancer among HIV-infected population in comparison with the HIVuninfected population (60/100,000 person-years, versus 2/100,000 person-years). Among HIV-infected men who have sex with men (MSM), the incidence of anal cancer is as high as 92-144/100,000 population. Like cervical cancer, squamous-cell canal cancer is caused predominantly by high-risk, oncogenic strains of human papillomaviruses (HPV) detected in 92% of HIV-positive MSM. The cervical and anal cancer share the same embryological origin, and occurs at a squamo-columnar transition zone, site of squamous intraepithelial lesions (SIL) as a result of the persistence HPV infection, especially the high-risk genotypes that may progress to invasive cancer. In the last decades, the incidence of squamous-cell anal carcinoma is increasing rapidly forcing the research of anal SIL (ASIL) cytology (PAP) and high-resolution anoscopy (HRA) colposcopic technique, emulating protocols for early detection of cervical cancer as a primary prevention. Objective: This study aimed to determine the prevalence of SCC precursor lesions. Determine sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) for the detection of anal dysplasia in the risk population. Material and Methods: Design prospective, cross-sectional, observational, analytical study. High-risk patients (HIV-positive MSM, patients with history of anogenital HPV, women with history of cancer or lower genital intraepithelial neoplasia) were included consecutively between April 2012 and February 2014 in Anal Early Detection Cancer Clinic...

Male , Female , Humans , Adult , Young Adult , Middle Aged , Anus Neoplasms/diagnosis , Anus Neoplasms/prevention & control , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/prevention & control , Squamous Intraepithelial Lesions of the Cervix/diagnosis , Papanicolaou Test , Proctoscopy/methods , Anal Canal/cytology , Anal Canal/injuries , Precancerous Conditions/diagnosis , Precancerous Conditions/pathology , Sensitivity and Specificity , Predictive Value of Tests , Risk Factors , Cross-Sectional Studies , Prospective Studies , Observational Studies as Topic
Rio de Janeiro; s.n; 2015. xiii,76 p. ilus, tab, graf, mapas.
Thesis in Portuguese | LILACS | ID: lil-774172


O Papiloma Vírus Humano (HPV) é o principal agente etiológico do câncer do trato anogenital. Uma maior prevalência e incidência de desenvolvimento do carcinoma e doenças associadas ao HPV têm sido observadas em indivíduos infectados pelo HIV. A história natural da infecção pelo HPV ainda não está totalmente elucidada, assim como aresposta imune que ocorre na co-infeção pelo HIV/HPV,principalmente na mucosa anal.Objetivo do presente estudo foi avaliar a resposta imune “in situ” em amostras de biópsias de indivíduos infectados pelo HIV em acompanhamento no Instituto Nacional de Infectologia/FIOCRUZ, RJ. Um total de 114 biópsias foi analisado através de TissueMicro-Array, sendo 15 de indivíduos Não infectados pelo HIV, todos sem lesão, e 99 deindivíduos Infectados pelo HIV: 21 sem lesão, 39 com NIA1, e 39 com NIA2/3. Foirealizado PCR e sequenciamento para identificação do DNA de HPV e imunohistoquímicapara análise dos marcadores imunes CD4, CD8, Foxp3, T-bet e IL-10 e SLPI. A análiseestatística foi feita no software SPSS 15.0 aplicando os testes: Kruskall-Wallis, Teste Quiquadradoe Teste Exato de Fisher. Pacientes Infectados pelo HIV com NIA 2/3apresentaram nadir CD4+ <50 cél/mm³ comparados aos pacientes normais (p = 0,01).Quanto aos marcadores imunes, indivíduos Infectados pelo HIV apresentaram uma maiorexpressão de Foxp3 e IL-10 de acordo com a gravidade da lesão (p= 0,002)...

Human Papillomavirus (HPV) is the main etiologic agent for lower genital tract cancers. Ahigher incidence and prevalence of these cancers has been reported in HIV infectedindividuals. The natural history of HPV infection is still unclear and the immune responsewith HIV/HPV co-infection, particularly in the anal mucosa, is poorly understood. The aimof this study was to evaluate the immune response in situ in ano-rectal biopsies fromHIV-infected patients followed up at the National Institute of Infectious Diseases /FIOCRUZ, RJ. A total of 114 biopsies were analyzed by Tissue Micro-Array: 15 were fromHIV negative individuals without any lesions and 99 from HIV-positive individuals: 21without lesions, 39 with AIN 1 and 39 with AIN 2/3. PCR and sequencing was run toidentify HPV DNA. CD4, CD8, Foxp3, T-bet, IL-10 and SLPI were analyzed byimmunohistochemistry. Statistical analysis was carried out using SPSS 15.0. TheKruskal-Wallis, chi-square and Fisher's exact tests were applied. HIV-positive patients withAIN 2/3 showed a nadir count of CD4 + <50 cells/mm³ compared to normal subjects (p =0.01). HIV positive individuals showed a higher expression of FoxP3 and IL-10 accordingto the severity of the lesion (p = 0.002). A positive coefficient correlation was foundbetween FoxP3 and IL-10 (0.34; p = 0.27). The analysis showed that 93.4 percent (101/107) ofthe samples had HPV DNA, and the most common types were: HPV 16 (26.9 percent), followedby HPV 6 (15.7 percent), HPV 59 (13 percent) and HPV 18 (10.2 percent). Interestingly, samples fromindividuals with high-risk oncogenic HPV DNA were negative for SLPI and there was lessexpression in AIN 2/3 compared to the no-lesion group of HIV + individuals, showing aninverse association with HPV type and degree of AIN...

Humans , AIDS-Related Opportunistic Infections , Carcinoma in Situ , Anal Canal/injuries , HIV-1 , Papillomaviridae
Säo Paulo med. j ; 132(4): 231-238, 07/2014. tab
Article in English | LILACS | ID: lil-714874


CONTEXT AND OBJECTIVE: Despite all the medical care provided during delivery labor, perineal injury is still prevalent and may lead to diverse pelvic floor disorders. The aim here was to investigate the prevalence of obstetric and anal sphincter injuries (OASIS) in healthy pregnant women after vaginal delivery. DESIGN AND SETTING: Cross-sectional study involving 3,034 patients with singletons in a secondary hospital for low-risk cases. METHODS: A standardized questionnaire was prepared and applied to medical files that had been completely filled out (classification of the Royal College of Obstetricians and Gynecologists, RCOG) in order to identify OASIS and analyze risk factors associated with mild and severe perineal lacerations. RESULTS: The women's mean age was 25 years; more than half (54.4%) were primiparae. Almost 38% of the participants had perineal lacerations; these were severe in 0.9% of the cases. Previous vaginal delivery (odds ratio, OR: 1.64 [1.33-2.04]) and forceps delivery (OR: 2.04 [1.39-2.97]) were risk factors associated with mild perineal injuries (1st and 2nd OASIS classifications). Only remaining standing for prolonged periods during professional activity (OR: 2.85 [1.34-6.09]) was associated with severe perineal injuries. CONCLUSION: The prevalence of severe perineal injuries was concordant with data in the literature. The variable of standing position was considered to be a risk factor for severe perineal injury and should be further investigated. .

CONTEXTO E OBJETIVOS: Apesar do cuidado médico executado durante o trabalho de parto, os traumas perineais ainda são prevalentes e podem levar a várias desordens do assoalho pélvico. O objetivo foi investigar a prevalência de injúrias obstétricas e do esfíncter anal em mulheres saudáveis após parto vaginal. DESENHO E LOCAL DE ESTUDO: Estudo transversal envolvendo 3.034 pacientes com recém-natos únicos de um hospital secundário de baixo risco. MÉTODOS: Um questionário padronizado foi preparado e aplicado aos prontuários completamente preenchidos (classificação do Royal College of Obstetricians and Gynecologists) para identificar as lesões obstétricas e do esfíncter anal e analisar fatores de risco associados com lacerações perineais leves e graves. RESULTADOS: A média de idade das mulheres era 25 anos; mais da metade (54,4%) era primípara. Quase 38% das participantes tiveram lacerações perineais; estas foram graves em 0,9% dos casos. A presença de parto vaginal prévio (odds ratio, OR, 1,64 [1,33-2,04]) e o parto fórceps (OR 2,04 [1,39-2,97]) foram fatores de risco associados às lesões perineais leves (primeira e segunda classificações de lesão esfíncter e anal). Somente a posição em pé prolongada durante a atividade profissional (OR 2,85 [1,34-6,09]) estava associada com lesões perineais graves. CONCLUSÃO: A prevalência de trauma perineal grave concordou com dados da literatura. A variável posição em pé foi considerada fator de risco para trauma perineal grave e necessita ser investigada. .

Adult , Female , Humans , Pregnancy , Young Adult , Anal Canal/injuries , Delivery, Obstetric/adverse effects , Lacerations/epidemiology , Obstetric Labor Complications/epidemiology , Perineum/injuries , Brazil/epidemiology , Cross-Sectional Studies , Episiotomy/adverse effects , Labor Stage, Second , Lacerations/classification , Multivariate Analysis , Odds Ratio , Prevalence , Posture/physiology , Risk Factors , Surveys and Questionnaires
Article in English | WPRIM | ID: wpr-124053


A perianal tick and the surrounding skin were surgically excised from a 73-year-old man residing in a southwestern costal area of the Korean Peninsula. Microscopically a deep penetrating lesion was formed beneath the attachment site. Dense and mixed inflammatory cell infiltrations occurred in the dermis and subcutaneous tissues around the feeding lesion. Amorphous eosinophilic cement was abundant in the center of the lesion. The tick had Y-shaped anal groove, long mouthparts, ornate scutum, comma-shaped spiracular plate, distinct eyes, and fastoons. It was morphologically identified as a fully engorged female Amblyomma testudinarium. This is the third human case of Amblyomma tick infection in Korea.

Aged , Anal Canal/injuries , Animals , Female , Histocytochemistry , Humans , Ixodidae/anatomy & histology , Korea , Male , Microscopy , Skin/parasitology , Tick Bites/diagnosis , Tick Infestations/diagnosis
Rev. argent. coloproctología ; 22(1): 4-9, mar. 2011. ilus, graf
Article in Spanish | LILACS | ID: lil-681092


Introducción: La incidencia del Cáncer de ano se encuentra en aumento tanto en pacientes HIV positivos o inmunosuprimidos como en los inmunocompetentes. Éste se asocia a la infección por HPV, con un comportamiento similar al del desarrollo del cáncer de cuello uterino, a través de la producción de lesiones intra-epiteliales escamosas (SIL). Para su diagnóstico se utiliza la anoscopía de alta resolución. Su tratamiento es aún controversial. Objetivo: Presentamos nuestra experiencia en el tratamiento quirúrgico de lesiones intra-epiteliales anales de alto grado (AIN III) guiadas con anoscopía de alta resolución. Lugar de aplicación o marco de referencia: Hospital Universitario. Diseño: Estudio retrospectivo. Material y métodos: Realizamos una revisión de los pacientes diagnosticados y operados (escisión/cauterización de las lesiones visualizadas con anoscopia de alta resolución) con diagnóstico de lesiones anales intra-epiteliales de alto grado (AIN III) en el marco del Programa de Prevención, Diagnóstico, Terapéutica y Vacunación en Patología del Tracto Genital Inferior del Hospital de Clínicas de Buenos Aires "José de San Martín". Resultados: A las pacientes con antecedentes de infección por HPV en el tracto genital inferior, se las evaluó con anoscopía magnificada. Entre enero de 2005 y agosto de 2010, se estudiaron 305 pacientes (32 inmunosuprimidas). De éstas, 18 (5.9%) presentaron lesiones intra-epiteliales de alto grado (AIN III) confirmadas por histología. Las mismas fueron remitidas para tratamiento quirúrgico. Tres eran inmunosuprimidas, dos por HIV. La edad media fue de 34 años (19-63 años). El seguimiento medio fue de 15 meses, 4 a 39 meses. Se produjo una recurrencia a los 4 meses. Ningún paciente desarrolló incontinencia, estenosis, infección postoperatoria, o hemorragia significativa después del tratamiento quirúrgico... (TRUNCADO)

Introduction: Over the last decades, anal cancer incidence rose to an epidemic range in general population and in some risk groups like inmuno-supressed or HIV patients. Anal cancer develops from squamous intraepithelial lesion (SIL) in the anal transitional zone produced by HPV infection. High resolution anoscopy is used to diagnose these dysplastic changes. There is no consensus about the best treatment option for high grade anal intraepithelial neoplasia (AIN III). Objective: To report our experience in the treatment of high grade anal intraepithelial neoplasia targeted by high resolution anoscopy. Design: Retrospective study. Material and method: Patients diagnose and treated for AIN III in the "Prevention, Diagnosis, Treatment and Vaccination of the Inferior Genital Tract" Program of the Hospital de Clínicas de Buenos Aires "José de San Martín". Results: Patients with history of HPV disease in the genital tract were studied with high resolution anoscopy. 305 patients (32 inmunosupressed) were studied between January of 2005 and August of 2010. 18 (5.9%) had AIN III and were surgically treated. Mean age was 34 years (19-63). Mean follow-up was 15 months (4 to 39). We observed one recurrenee at 4 month. No complications were present. Conclusions: High resolution anoscopy targeted surgery AIN III is feasible and seams to eradicate these lesions in the inmunocompetent patient.

Humans , Adult , Middle Aged , Anal Canal/surgery , Anal Canal/injuries , Papillomavirus Infections/complications , Anus Neoplasms/surgery , Anus Neoplasms/diagnosis , Anus Neoplasms/etiology , Carcinoma in Situ/surgery , Carcinoma in Situ/diagnosis , Carcinoma in Situ/etiology , HIV Infections/complications , Precancerous Conditions/diagnosis , Proctoscopy/methods
Rev. argent. coloproctología ; 21(2): 78-81, abr.-jul. 2010.
Article in Spanish | LILACS | ID: lil-605361


Introducción: En los últimos años, la aplicación de métodos de diagnóstico tales como el PAP anal y la Anoscopia de Alta Resolución (AAR) en población de alto riesgo permite una pesquisa diagnóstica temprana del cáncer invasor del conducto anal abriendo las puertas a la posibilidad curativa. El objetivo del siguiente estudio es presentar dos casos clínicos con neoplasia intraepitelial anal (NIA) hallados en la pieza de anatomía patología poshemorroidectomía en los que se utilizó la AAR para dirigir la conducta a seguir. Material y método: En el “H.I.G.A. Prof. Dr. Luis Güemes”, Haedo, provincia de Buenos Aires, en el período comprendido entre el 01/01/08 al 06/06/09, fueron halladas en la pieza de hemorroidectomía dos NIA. Ninguno de estos dos pacientes presentaba factores de riesgo para carcinoma de ano previo a la cirugía hemorroidal. A ambos pacientes se les realizó AAR con el objetivo de reconocer la extensión de las lesiones para su completa resección. Resultados: La visualización de la localización y extensión de la lesión a través de la AAR, permitió la correcta elección del área de resección y márgenes de seguridad oncológicos adecuados. Conclusiones: La AAR tiene la ventaja de ser utilizada como localizador de lesiones no visibles por otro método, luego del hallazgo de atipias o lesiones premalignas mucosas; es por ello que el entrenamiento en el método resulta indispensable como complemento diagnóstico.

Introduction: Recently, the use of diagnostic methods such us anal cytolgy and high resolution anoscopy (HRA) in high risk population allows an early diagnosis of invasive anal cancer which increases chances of cure. The objective of the following study is to present two cases with anal intraepithelial neoplasia found in pathologie specimen where high resolution anoscopy was used to guide the next course of action. Patients and methods: In H.I.G.A. Prof. Dr. L. Güemes, Haedo Bs. As. Province, between 01/01/08 and 06/06/09, one anal intraepithelial neoplasia and one invasive anal cancer were found in the hemorrhoidectomy piece. Neither of these two patients showed risk factors for anal cancer previous to hemorrhoid surgery. Both patients were treated with HRA with the purpose of recognizing the extent of the injuries to be fully resected. Result: Spotting the localization and extension of the injuries through HRA enabled the physician to choose margins. Conclusions: The HRA has the advantage to be used as a localizer of lesions that can't be seen otherwise, as from the finding of atypia or premalignant mucosal lesion. That is the reason why the training in these methods is essential as a complementary test.

Humans , Female , Middle Aged , Anal Canal/surgery , Anal Canal/injuries , Anal Canal/pathology , Proctoscopy/methods , Diagnosis, Differential , Anus Neoplasms/surgery , Anus Neoplasms/diagnosis
Rev. bras. colo-proctol ; 29(3): 297-302, jul.-set. 2009. tab
Article in Portuguese | LILACS | ID: lil-533538


OBJETIVO: comparar os resultados da coleta única com duas amostras para avaliar se haverá melhora da sensibilidade e especificidade do exame. MÉTODO: Foram 112 doentes masculinos HIV-positivo com doença anal pregressa ou atual pelo Papilomavírus humano (HPV). As lesões HPV induzidas foram observadas em 58 deles. Colhemos material do canal anal utilizando duas escovas (cytobrush) Comparamos estatisticamente os resultados da primeira amostra com a soma das duas coletas. RESULTADOS: dos 58 doentes com lesões clínicas, a primeira amostra confirmou a doença em 40 (69 por cento) e a soma das duas coletas revelou lesões em 51 (88 por cento). Os resultados mostraram sensibilidade de 69 por cento com a primeira coleta e 88 por cento quando somadas as duas amostras. Essa diferença foi confirmada estatisticamente. A especificidade foi menor para as duas amostras, porém sem diferença estatística. CONCLUSÃO: Concluímos que a sensibilidade foi maior e a especificidade foi semelhante quando os resultados foram obtidos com a somação das duas amostras da citologia anal.

OBJECTIVE: The aim of this study was to know if two smears may have better sensibility and specificity than a unique smear for anal cytology. METHOD: There were 112 patients, males, HIV-positive, with current or previous anal HPV-induced lesions. Proctological examination revealed clinical disease in the anal canal of 58 of them. Smears were collect with cytobrushes. We compared results of the first smear to a sum of this with a second one. RESULTS: First smear was positive in 40 patients (69 percent), and with both smears this incidence reached 88 percent. Results showed sensibility of 69 percent to the unique smear, and 88 percent when both were summed. Statistics revealed significant difference. Specificity was higher when both smears were summed, but statistics showed no difference. CONCLUSION: We concluded sensibility of anal cytology was better and specificity was similar when results were obtained with a sum of two smears.

Humans , Male , Carcinoma, Squamous Cell , Anal Canal/injuries , HIV Infections , Papillomavirus Infections
Indian J Pediatr ; 2009 June; 76(6): 653-654
Article in English | IMSEAR | ID: sea-142308


A six-year-old female victim of sexual assault, with grade IV perineal injury with massive intestinal prolapse out of the perineum, is reported to highlight the severity of injury during sexual assaults.

Anal Canal/injuries , Child , Child Abuse, Sexual , Female , Genitalia, Female/injuries , Genitalia, Female/surgery , Humans , Intestinal Diseases/etiology , Intestinal Diseases/surgery , Perineum/injuries , Prolapse , Subarachnoid Hemorrhage/etiology , Vagina/injuries