ABSTRACT
High-grade anal intraepithelial squamous lesion is significantly prevalent among men who have sex with men and are infected with the human immunodeficiency virus. This condition-the precursor to anal cancer-significantly increases the risk of developing it. Conversely, low-grade anal intraepithelial squamous typically follow a benign course and usually regress spontaneously. MATERIALS AND METHODS: To describe a population of men who have sex with men living with human immunodeficiency virus followed in a specialized anal cancer screening unit we conducted an observational, retrospective, and single-center study was. RESULTS: Ninety-four patients were analyzed, with a mean age of 39 ± 9 years, and a 87% positivity rate for high-risk human papillomavirus (HR-HPV). At the initial visit, 47% presented with low-grade squamous intraepithelial lesions. The progression rate to high-grade squamous intraepithelial lesion was 37.2 per 100,000 patients/year. None of the patients developed anal cancer. Tobacco and alcohol consumption were associated with this progression. DISCUSSION: In this series, longer duration of HIV infection, tobacco and alcohol use and the presence of HR-HPV were significantly associated with the occurrence of high-grade intraepithelial lesions. A lower risk of progression was seen in patients with higher education. CONCLUSION: In men who have sex with men living with HIV, the association of factors such as smoking, alcohol, the presence of HR-HPV and an increased burden of human papillomavirus disease makes these patients more susceptible to develop high-grade anal squamous lesions.
ABSTRACT
La transferencia de colgajos libres es una herramienta fundamental dentro del arsenal reconstructivo para el tratamiento quirúrgico del gran quemado. Durante años ha existido controversia sobre la influencia del momento de la cirugía sobre la tasa de complicaciones, así como el alto riesgo de complicaciones al realizar reconstrucciones con colgajos libres en pacientes quemados. Diseñamos un estudio retrospectivo de las reconstrucciones quirúrgicas mediante colgajos libres realizadas en nuestra Unidad de Quemados del Hospital Universitari y Politecnic La Fe, de Valencia (España) en el periodo comprendido entre 2001 y 2013, recogiendo todos los datos relativos al paciente, a la lesión, al procedimiento reconstructivo, a los resultados y relacionando todo ello con el momento en el cual se realizó la cirugía. Para el análisis de los datos y asociaciones entre distintas variables usamos tablas de contingencia y aplicamos el test de independencia de Chi-cuadrado. Exponemos además 2 casos clínicos representativos de la cirugía reconstructiva practicada en pacientes quemados. Recogimos en total datos de 21 procedimientos de reconstrucción mediante colgajo libre en pacientes quemados. En ninguno se realizó reconstrucción primaria inmediata (en los primeros 5 días), mientras que la reconstrucción primaria temprana (entre el día 5 y el 21) se realizó en el 28,57% de los casos, la primaria intermedia (entre el día 21 y las 6 semanas) en el 28,57%, la secundaria (más de 6 semanas) en el 9,5%, y la cirugía de secuelas en el 33,33% de los casos. Las tasas de complicaciones mayores y menores fueron respectivamente 19,05% y 9,5%. El 50% de complicaciones mayores ocurrieron en el periodo de reconstrucción primaria temprana, mientras que no registramos ninguna en el periodo primario intermedio. El resto de complicaciones se repartió a partes iguales entre el periodo secundario y la cirugía de secuelas (ambas con el 25%). No encontramos asociación estadísticamente significativa entre las variables en ninguna de las comparaciones realizadas. En conclusión, creemos que la reconstrucción mediante colgajos libres en pacientes quemados presenta un riesgo más elevado de complicaciones mayores cuando se realiza en el periodo primario temprano (entre los días 5 y 21 tras la quemadura) (AU)
Free flap transfer is an essential tool within the reconstructive repertoire for the surgical treatment of major burn patients. For a long time there has been controversy about the influence of the timing over the complication rate, as well as the increased complication risk when we perform reconstruction by means of free flaps in burn patients. We designed a retrospective study about free flap reconstructions performed in our Burns Unit at the Hospital Universitari y Politecnic La Fe, Valencia (Spain), in the period from 2001 to 2013, collecting data related to the patient, the lesion, the reconstructive procedure, the results, and all this data related to timing. For the data analysis and associations between the different variables we used contingency tables and applied the Chi-square independence test. In addition we present 2 representative clinical reports about burn reconstructive surgery. Data from 21 reconstructive procedures with free flaps in burn patients were collected. Immediate primary reconstruction (in the first 5 days) is not performed in any patient, while early primary reconstruction (from day 5 to 21) was performed in 28,57% of cases; the intermediate primary reconstruction (from day 21 to 6th week) was performed in 28,57%, the secondary reconstruction (more than 6 weeks) in 9,5% and sequelae surgery in 33,33% of the cases. Major and minor complication rate were 19,05% and 9,5% respectively; 50% of major complications happened in early primary reconstruction period, whereas no complication is registered in intermediate primary period, the rest of complications are equally divided between secondary reconstruction period and sequelae surgery (both of them 25%). No statistically significant association between the variables is found in any of the comparisons performed. In conclusion, we think that reconstruction with free flaps applied to burn patients presents a higher major complication rate when performed in the early primary period (from day 5 to day 21 after the burn) (AU)
