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.

[Anorectal manometry and ultrasound in the study of patients with fecal incontinence]. / Ecografía anorrectal y manometría en el estudio de pacientes con incontinencia fecal.

INTRODUCTION: Fecal incontinence is a complex disease that affects the quality of life of patients suffering from it. Anorectal manometry and endoanal ultrasound 360 grades are included among the studies used. There are no clear agreement about the relevance and usefulness of this studies and their role as apart of diagnostic procedures. OBJECTIVE: To describe the relationship between the clinical severity score in patients with fecal incontinence and the findings of anorectal manometry and endoanal ultrasound. Another objective of this study is to describe the degree of agreement of both methods of study. MATERIAL AND METHODS: The study population includes 74 patients who underwent endoanal ultrasonography and anorectal manometry for fecal incontinence. The presence or absence of ultrasound injury, the pressures obtained by anorectal manometry and its relationship with clinical severity of patients were described. An analysis of the degree of agreement between both methods was performed. RESULTS: The mean age of patients was 53 years old (range 19-84 years). Pressures of anorectal manometry were reduced in 59 patients (79.7%) and normal in 15 (20.3%). The assessment of the degree of agreement or concordance between ultrasound and anorectal manometry yielded a kappa coefficient of 0.25 (acceptable) (P = 0.0001). CONCLUSION: There is a level of acceptable agreement between endoanal ultrasound findings and anorectal manometry when patients with fecal incontinence are evaluated.

[Prevention of colorectal cancer]. / Prevención del cáncer colorrectal (CCR).

Colorectal cancer (CRC) is the second leading cause of cancer death in Argentina. The cumulative lifetime risk of developing CRC for both men and women is 4-6%. Despite advances in the management of this disease, the 5-year survival rate is about 60% because only 35% of patients are diagnosed when the disease is localized. Risk factors for CRC include age, diet and life style factors, personal or family history of adenomas or CRC and personal history of inflammatory bowel disease. Scientific evidence shows that primary and secondary prevention, through screening programs, permit to reduce incidence and mortality significantly. Chemopreventive agents, including nonsteroidal antiinflammatory drugs, folate, and calcium, have been shown to have some preventive effect. Physical inactivity and excess body weight are consistent risk factors for CRC. Tobacco exposure, diet high in red meat and low in vegetables and alcohol consumption, probably in combination with a diet low in folate, appear to increase risk. The dietary fiber and risk of CRC has been studied but the results are still inconclusive. Screening for CRC is cost-effective compared with no screening, but a single optimal strategy cannot be determined from the currently available data. The advantages and disadvantages or limitations of screening modalities for CRC are analyzed. The literature and clinical practice guidelines are reviewed, with an emphasis on advances and evolving screening methods and recommendations for patients with average, moderate and high-risk CRC.

Prevención del cáncer colorrectal (CCR). / [Prevention of colorectal cancer]

Colorectal cancer (CRC) is the second leading cause of cancer death in Argentina. The cumulative lifetime risk of developing CRC for both men and women is 4-6

. Despite advances in the management of this disease, the 5-year survival rate is about 60

because only 35

of patients are diagnosed when the disease is localized. Risk factors for CRC include age, diet and life style factors, personal or family history of adenomas or CRC and personal history of inflammatory bowel disease. Scientific evidence shows that primary and secondary prevention, through screening programs, permit to reduce incidence and mortality significantly. Chemopreventive agents, including nonsteroidal antiinflammatory drugs, folate, and calcium, have been shown to have some preventive effect. Physical inactivity and excess body weight are consistent risk factors for CRC. Tobacco exposure, diet high in red meat and low in vegetables and alcohol consumption, probably in combination with a diet low in folate, appear to increase risk. The dietary fiber and risk of CRC has been studied but the results are still inconclusive. Screening for CRC is cost-effective compared with no screening, but a single optimal strategy cannot be determined from the currently available data. The advantages and disadvantages or limitations of screening modalities for CRC are analyzed. The literature and clinical practice guidelines are reviewed, with an emphasis on advances and evolving screening methods and recommendations for patients with average, moderate and high-risk CRC.

Quiste dermoideo sacrococcigeo malignizado / Sacrococcygeal dermoid cyst

Se presenta un caso de quiste dermoideo sacrococcígeo con transformación carcinomatosa, destacando su baja incidencia, como los factores que determinarían el cambio celular. Se hace una revisión de la casuística mundial y se analizan los métodos de diagnóstico, tratamiento e índices de recurrencia y sobrevida (AU)

Duplicación de colon / Colon duplication

Se presenta un caso de duplicación tubular rectocolónica. Llama la atención el hallazgo de la misma en una persona adulta ya que es habitual su presentación en niños o recién nacidos. Algunas de las teorías que tratan de explicar esta malformación son expuestas. La dificultad diagnóstica, signos, síntomas y patología asociada son mencionados. Se discute el caso y el tratamiento quirúrgico adoptado (AU)

Quiste dermoideo sacrococcigeo malignizado / Sacrococcygeal dermoid cyst

Se presenta un caso de quiste dermoideo sacrococcígeo con transformación carcinomatosa, destacando su baja incidencia, como los factores que determinarían el cambio celular. Se hace una revisión de la casuística mundial y se analizan los métodos de diagnóstico, tratamiento e índices de recurrencia y sobrevida

Duplicación de colon / Colon duplication

Se presenta un caso de duplicación tubular rectocolónica. Llama la atención el hallazgo de la misma en una persona adulta ya que es habitual su presentación en niños o recién nacidos. Algunas de las teorías que tratan de explicar esta malformación son expuestas. La dificultad diagnóstica, signos, síntomas y patología asociada son mencionados. Se discute el caso y el tratamiento quirúrgico adoptado