Manejo Clínico ­ Quirúrgico de pacientes con Fisura Anal en la Unidad de Coloproctología del HECAM / Clinical-Surgical Management of patients with Anal Fissure in the Unit HECAM Coloproctology

La fisura anal es una de las enfermedades más antiguamente descritas, la misma que, ha tenido hasta el momento múltiples tratamientos tanto médicos como quirúrgicos, existiendo controversias en su algoritmo terapéutico. Constituye una de las patologías cuyo diagnóstico y tratamiento corresponde a la Especialidad de Coloproctología, afecta a ambos sexos y a cualquier edad y puede ser aguda o crónica. Proponemos el presente Protocolo para un adecuado manejo de la patología, de manera que sirva de guía en la toma correcta de decisiones basadas en la evidencia y el consenso de quienes integramos la Unidad Técnica de Coloproctología del Hospital de Especialidades Carlos Andrade Marín.

Anal fissure is one of the oldest described diseases, which has so far had multiple medical and surgical treatments, with controversies in its therapeutic algorithm. It is one of the pathologies whose diagnosis and treatment corresponds to the Coloproctology Specialty, it affects both sexes and any age and can be acute or chronic. We propose the present Protocol for an adequate management of the pathology, so that it serves as a guide in the correct decision making based on evidence and consensus of those who integrate the Technical Unit of Coloproctology of the Hospital de Especialidades Carlos Andrade Marín.

Sarcoma de Kaposi anoperineal: uma rara apresentação / Perineal Kaposi's Sarcoma: a rare presentation

O sarcoma de Kaposi é uma neoplasia maligna associada à infecção pelo herpes vírus humano 8 em doentes imunossupressos. O sarcoma de Kaposi Epidêmico é o tipo epidemiológico mais frequente e afeta indivíduos VIH-positivos. A região anoperineal é raramente envolvida e as lesões suspeitas devem ser biopsiadas para confirmação histológica. A base do tratamento é a restauração imune do doente. Relatamos o caso de um jovem, com diagnóstico recente de infeção pelo VIH, sem tratamento, que foi admitido no serviço de infectologia apresentando sintomas constitucionais, adenomegalias inguinais e extensa lesão verrucosa e ulcerada na região anoperineal. As biópsias confirmaram o diagnóstico de sarcoma de Kaposi e o doente iniciou terapia antirretroviral e quimioterapia. Houve recuperação clínica, regressão das lesões e desaparecimento das adenomegalias. Este relato objetiva alertar as equipes médicas no sentido de se incluir o sarcoma de Kaposi no diagnóstico diferencial das lesões que afetam a região anoperineal.

Kaposi's sarcoma is a malignant neoplasm associated with human herpesvirus 8 infection in immunocompromised patients. Epidemic Kaposi's sarcoma is the most common epidemiological type and affects HIV-positive patients. Perineal involvement is rare, and suspicious lesions should be biopsied to confirm histological diagnosis. Treatment consists of restoring the patient's immune system. We report the case of a young patient recently diagnosed with HIV, without treatment, who was admitted to the Department of Infectious Diseases with nonspecific symptoms, inguinal lymphadenopathy, and an extensive verrucous ulcerated lesion in the perineal region. Biopsy confirmed the diagnosis of Kaposi's sarcoma, and the patient was started on antiretroviral therapy and chemotherapy. Clinical recovery was achieved, with lesion reduction and inguinal adenopathy resolution. This case report aims to encourage physicians to include Kaposi's sarcoma in the differential diagnosis of perineal lesions.

Anorectal diseases in patients with Antiphospholipid syndrome: a cross-sectional study.

BACKGROUND: Hemorrhoid disease (HD) is one of the most common gastrointestinal complaints worldwide, affecting 4.4% of the general population in the United States. Since antiphospholipid syndrome (APS) may lead to intra-abdominal thrombosis, one may expect that this condition can impact the risk for HD development. Additionally, as APS patients are more prone to thrombosis and treatment with anticoagulants may increase risk of bleeding, one may also infer that rates of HD complications may be higher in this scenario. Nevertheless, no data in these regards have been published until now. The objective of the present study is to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients. METHODS: We consecutively invited patients who fulfilled APS criteria to undergo proctological examination. After examination, patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile. We performed the analysis of the data, using chi-square and Mann Whitney U when applicable and considering a significance level of 0.05. Multivariate regression analysis included age and variables with p < 0.10 in the bivariate analysis. RESULTS: Forty-one APS patients agreed to undergo proctological examination. All were female and overall median age was 43 (36-49). Seventeen (41.4%) patients were diagnosed with HD, with the following frequency distribution: 7 internal (41.2%), 4 external (23.5%) and 5 mixed hemorrhoids (29.4%). Of the internal hemorrhoids, 5 patients were classified as grade I (71.4%), 1 grade II (14.3%), and 1 grade IV (14.3%). Prior gestation (p = 0.067) and constipation (p = 0.067) correlated with a higher frequency of HD. In multivariate analysis, constipation remained as an important risk factor (OR 3.92,CI95% 1.03-14.2,p = 0.037). Five out of 17 patients (29.4%) reported anal bleeding, but it did not correlate with warfarin dose (p = 0.949). Surgical treatment was indicated for 10 patients (58.8%). Other anorectal findings were anal fissure, plicoma, condyloma and one chlamydial retitis. CONCLUSION: We found an unexpected high frequency of hemorrhoids in APS patients, with a great proportion requiring surgical treatment.

Anorectal diseases in patients with Antiphospholipid syndrome: a cross-sectional study

Abstract Background: Hemorrhoid disease (HD) is one of the most common gastrointestinal complaints worldwide, affecting 4.4% of the general population in the United States. Since antiphospholipid syndrome (APS) may lead to intra-abdominal thrombosis, one may expect that this condition can impact the risk for HD development. Additionally, as APS patients are more prone to thrombosis and treatment with anticoagulants may increase risk of bleeding, one may also infer that rates of HD complications may be higher in this scenario. Nevertheless, no data in these regards have been published until now. The objective of the present study is to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients. Methods: We consecutively invited patients who fulfilled APS criteria to undergo proctological examination. After examination, patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile. We performed the analysis of the data, using chi-square and Mann Whitney U when applicable and considering a significance level of 0.05. Multivariate regression analysis included age and variables with p < 0.10 in the bivariate analysis. Results: Forty-one APS patients agreed to undergo proctological examination. All were female and overall median age was 43 (36-49). Seventeen (41.4%) patients were diagnosed with HD, with the following frequency distribution: 7 internal (41.2%), 4 external (23.5%) and 5 mixed hemorrhoids (29.4%). Of the internal hemorrhoids, 5 patients were classified as grade I (71.4%), 1 grade II (14.3%), and 1 grade IV (14.3%). Prior gestation ( p = 0.067) and constipation ( p = 0.067) correlated with a higher frequency of HD. In multivariate analysis, constipation remained as an important risk factor (OR 3.92,CI95% 1.03-14.2, p = 0.037). Five out of 17 patients (29.4%) reported anal bleeding, but it did not correlate with warfarin dose ( p = 0.949). Surgical treatment was indicated for 10 patients (58.8%). Other anorectal findings were anal fissure, plicoma, condyloma and one chlamydial retitis. Conclusion: We found an unexpected high frequency of hemorrhoids in APS patients, with a great proportion requiring surgical treatment.(AU)

Treatment of fistula-in-ano with cyanoacrylate glue with and without prior seton placement in rats

PURPOSE:To evaluate the efficacy of ethyl-cyanoacrylate in the treatment of fístula-in-ano in rats with and without prior seton placement.METHODS:Thirty rats Wistar with fístula-in-ano produced surgically, distributed in three groups: group A (ethyl-cyanoacrylate) - treated by application of ethyl-cyanoacrylate into fístula tract; group B (seton + ethyl-cyanoacrylate) - seton placement followed by application of ethyl-cyanoacrylate into fístula tract, 30 days later; group C (control) - no treatment. After 60 days the animals were submited to euthanasia and the specimens were analyzed by pathologist. The results were analyzed by Chi-square test with significant value of p<0.05.RESULTS:One animal of group B died. Were found tracts fully healed: 7, 5 and 2, in groups A, B and C, respectivelly. There was a statistically significant difference between groups A and C (p=0.02). When joined all animals treated with glue (A + B) compared to group C there was also statistically significant difference (p=0.02).CONCLUSIONS:The use of ethyl-cyanoacrylate glue was effective in closing anal fistulae in rats. There was no advantage in the prior application of seton.(AU)

Treatment of fistula-in-ano with cyanoacrylate glue with and without prior seton placement in rats

ABSTRACT PURPOSE: To evaluate the efficacy of ethyl-cyanoacrylate in the treatment of fístula-in-ano in rats with and without prior seton placement. METHODS: Thirty rats Wistar with fístula-in-ano produced surgically, distributed in three groups: group A (ethyl-cyanoacrylate) - treated by application of ethyl-cyanoacrylate into fístula tract; group B (seton + ethyl-cyanoacrylate) - seton placement followed by application of ethyl-cyanoacrylate into fístula tract, 30 days later; group C (control) - no treatment. After 60 days the animals were submited to euthanasia and the specimens were analyzed by pathologist. The results were analyzed by Chi-square test with significant value of p<0.05. RESULTS: One animal of group B died. Were found tracts fully healed: 7, 5 and 2, in groups A, B and C, respectivelly. There was a statistically significant difference between groups A and C (p=0.02). When joined all animals treated with glue (A + B) compared to group C there was also statistically significant difference (p=0.02). CONCLUSIONS: The use of ethyl-cyanoacrylate glue was effective in closing anal fistulae in rats. There was no advantage in the prior application of seton.

Linfangioma perianal: relato de caso / Perianal lymphangioma: case report

O linfangioma é um tumor benigno que pode se desenvolver em qualquer região do corpo, uma vez que se origina de lesão dos vasos linfáticos. A apresentação perianal deste tipo de tumor é rara. O histórico do paciente e o exame físico nos levaram a suspeitar do tumor e identificá-lo. Este relato de caso envolve um paciente do sexo masculino com histórico de tumor que pode ser encontrado na região perineal. O tratamento escolhido foi cirurgia e o diagnóstico definitivo dado pelo patologista.

Lymphangioma is a benign tumor that can develop anywhere on the body, since it is derived from a lesion of the lymphatic vessels. Perianal presentation of this kind of tumor is rare. Patient history and a physical examination led us to suspect and identify the tumor. This case report is about a male patient with a history of a tumor that can be found throughout the perineal area. The treatment of choice is surgery and definitive diagnosis is given by the pathologist.

Morphometric analysis of dendritic cells from anal mucosa of HIV-positive patients and the relation to intraepithelial lesions and cancer seen at a tertiary health institution in Brazil / Análise morfométrica das células dendríticas da mucosa anal de pacientes HIV-positivos e relação com as lesões intraepiteliais e o câncer numa instituição de saúde terciária no Brasil

PURPOSE: To morphometrically quantify CD1a+ dentritic cells and DC-SIGN+ dendritic cells in HIV-positive patients with anal squamous intraepithelial neoplasia and to evaluate the effects of HIV infection, antiretroviral therapy and HPV infection on epithelial and subepithelial dendritic cells. METHODS: A prospective study was performed to morphometrically analyze the relative volume of the dendritic cells and the relationship between anal intraepithelial neoplasia and cancer in HIV-positive patients from the Tropical Medicine Foundation of Amazonas, Brazil. All patients were submitted to biopsies of anorectal mucosa to perform a classic histopathological and immunohistochemical analysis, employing antibodies against CD1a and DC-SIGN for the morphometric quantification of dendritic cells. RESULTS: HIV-negative patients displayed a CD1a DC density significantly higher than that of HIV-positives patients (3.75 versus 2.54) (p=0.018), and in patients with severe anal intraepithelial neoplasia had correlated between DC CD1a density with levels of CD4 + cells (p: 0.04) as well as the viral load of HIV-1 (p: 0.035). A not significant rise in the median density of CD1a+ DC was observed in the HIV positive/ HAART positive subgroup compared to the HIV positive/ HAART negative subgroup. The CD1a+ DC were also significantly increased in HIV-negative patients with anorectal condyloma (2.33 to 3.53; p=0.05), with an opposite effect in HIV-positive patients. CONCLUSIONS: Our data support an enhancement of the synergistic action caused by HIV-HPV co-infection on the anal epithelium, weakening the DC for its major role in immune surveillance. Notoriously in patients with severe anal intraepithelial neoplasia, the density of CD1a+ epithelial dendritic cells was influenced by the viral load of HIV-1.(AU)

OBJETIVO: Quantificar morfometricamente as células dendríticas DC CD1a+ e DC DC-SIGN+ em pacientes HIV positivos portadores de neoplasia escamosa intraepitelial anal e avaliar os efeitos da infecção pelo HIV, da terapia antirretroviral e da infecção pelo HPV sobre as células dendríticas epiteliais e subepiteliais. MÉTODOS: Um estudo prospectivo foi realizado para analisar morfometricamente o volume relativo das células dendríticas e as relações entre neoplasia intraepitelial anal e o câncer em pacientes HIV positivos da Fundação de Medicina Tropical do Amazonas, Brasil.Todos os pacientes foram submetidos a biópsia da mucosa retal para realizar uma análise clássica histopatológica e imunohistoquímica utilizando anticorpos contra anti-CD1a e anti-DC-SIGN, para a quantificação morfométrica das células dendríticas. RESULTADOS: Os pacientes HIV negativos apresentaram densidade das DC CD1a+ significativamente maior do que a dos pacientes HIV positivos (3,75 versus 2,54) (p:0,018), e os pacientes com severa apresentaram correlação das DC CD1a com os níveis de células TCD4(p:0,04) assim como a carga viral do HIV-1 (p:0,035). Observamos no subgrupo HIV-positivo/HAART positivo elevação não significativa na mediana da densidade das DC CD1a+ em relação ao grupo HIV-positivo/HAART negativo. As DC CD1a+ também se elevaram nos pacientes HIV negativo portadores de condiloma anorretal(2,33 para 3,53; p:0,05), com efeito inverso nos pacientes HIV positivos. CONCLUSÕES: Nossos dados confirmam a potencialização da ação sinérgica representada pela coinfecção HIV-HPV sobre o epitélio anal, fragilizando as DC em sua função primordial de vigilância imune. Notoriamente nos pacientes com neoplasia intraepithelial anal grave, a densidade das DC CD1a+ epiteliais sofreu influência da carga viral do HIV-1.(AU)

Morphometric analysis of dendritic cells from anal mucosa of HIV-positive patients and the relation to intraepithelial lesions and cancer seen at a tertiary health institution in Brazil / Análise morfométrica das células dendríticas da mucosa anal de pacientes HIV-positivos e relação com as lesões intraepiteliais e o câncer numa instituição de saúde terciária no Brasil

PURPOSE: To morphometrically quantify CD1a+ dentritic cells and DC-SIGN+ dendritic cells in HIV-positive patients with anal squamous intraepithelial neoplasia and to evaluate the effects of HIV infection, antiretroviral therapy and HPV infection on epithelial and subepithelial dendritic cells. METHODS: A prospective study was performed to morphometrically analyze the relative volume of the dendritic cells and the relationship between anal intraepithelial neoplasia and cancer in HIV-positive patients from the Tropical Medicine Foundation of Amazonas, Brazil. All patients were submitted to biopsies of anorectal mucosa to perform a classic histopathological and immunohistochemical analysis, employing antibodies against CD1a and DC-SIGN for the morphometric quantification of dendritic cells. RESULTS: HIV-negative patients displayed a CD1a DC density significantly higher than that of HIV-positives patients (3.75 versus 2.54) (p=0.018), and in patients with severe anal intraepithelial neoplasia had correlated between DC CD1a density with levels of CD4 + cells (p: 0.04) as well as the viral load of HIV-1 (p: 0.035). A not significant rise in the median density of CD1a+ DC was observed in the HIV positive/ HAART positive subgroup compared to the HIV positive/ HAART negative subgroup. The CD1a+ DC were also significantly increased in HIV-negative patients with anorectal condyloma (2.33 to 3.53; p=0.05), with an opposite effect in HIV-positive patients. CONCLUSIONS: Our data support an enhancement of the synergistic action caused by HIV-HPV co-infection on the anal epithelium, weakening the DC for its major role in immune surveillance. Notoriously in patients with severe anal intraepithelial neoplasia, the density of CD1a+ epithelial dendritic cells was influenced by the viral load of HIV-1. Our study describes for the first time the density of subepithelial DC-SIGN+ dendritic cells in patients with anal severe anal intraepithelial neoplasia and points to the possibility that a specific therapy for HIV induces the recovery of the density of epithelial DC.

OBJETIVO: Quantificar morfometricamente as células dendríticas DC CD1a+ e DC DC-SIGN+ em pacientes HIV positivos portadores de neoplasia escamosa intraepitelial anal e avaliar os efeitos da infecção pelo HIV, da terapia antirretroviral e da infecção pelo HPV sobre as células dendríticas epiteliais e subepiteliais. MÉTODOS: Um estudo prospectivo foi realizado para analisar morfometricamente o volume relativo das células dendríticas e as relações entre neoplasia intraepitelial anal e o câncer em pacientes HIV positivos da Fundação de Medicina Tropical do Amazonas, Brasil.Todos os pacientes foram submetidos a biópsia da mucosa retal para realizar uma análise clássica histopatológica e imunohistoquímica utilizando anticorpos contra anti-CD1a e anti-DC-SIGN, para a quantificação morfométrica das células dendríticas. RESULTADOS: Os pacientes HIV negativos apresentaram densidade das DC CD1a+ significativamente maior do que a dos pacientes HIV positivos (3,75 versus 2,54) (p:0,018), e os pacientes com severa apresentaram correlação das DC CD1a com os níveis de células TCD4(p:0,04) assim como a carga viral do HIV-1 (p:0,035). Observamos no subgrupo HIV-positivo/HAART positivo elevação não significativa na mediana da densidade das DC CD1a+ em relação ao grupo HIV-positivo/HAART negativo. As DC CD1a+ também se elevaram nos pacientes HIV negativo portadores de condiloma anorretal(2,33 para 3,53; p:0,05), com efeito inverso nos pacientes HIV positivos. CONCLUSÕES: Nossos dados confirmam a potencialização da ação sinérgica representada pela coinfecção HIV-HPV sobre o epitélio anal, fragilizando as DC em sua função primordial de vigilância imune. Notoriamente nos pacientes com neoplasia intraepithelial anal grave, a densidade das DC CD1a+ epiteliais sofreu influência da carga viral do HIV-1. Nosso estudo descreveu pela primeira vez a densidade das DC subepiteliais DC-SIGN+ em pacientes com neoplasia intraepithelial anal severa e apontamos para a possibilidade de que a terapia específica para o HIV induza a recuperação da densidade das DC epiteliais.

Is dynamic two-dimensional anal ultrasonography useful in the assessment of anismus? A comparison with manometry / A ultrassonografia anal bi-dimensional pode ser utilizada na avaliacão do anismus? Estudo comparativo com a manometria

CONTEXT: Anismus is a prevalent functional cause of outlet delay. It is characterized by symptoms of obstructed defecation associated with paradoxical contraction of the pelvic floor muscles. OBJECTIVE: To evaluate the ability of two dimensional anal ultrasonography to identify anismus patients with paradoxical contraction or normal relaxation, comparing findings with manometric measurements. METHODS: Forty-nine women presenting with outlet delay and a mean validated Wexner constipation score of 13.5 were included in a prospective study. Following screening with anal manometry, the patients were assigned to one of two groups: G-I -with normal relaxation and G-II -patients with anismus. Dynamic anorectal ultrasonography was used to quantifier the movement of the puborectalis muscle and to measure changes in the angle between two converging lines drawn from the 3 o'clock and the 9 o'clock positions of the endoprobe circumference to the internal border of the puborectalis muscle. The angle decreases during straining in patients with normal relaxation, but increases in patients with anismus. The agreement between the two techniques was verified with the Kappa index. RESULTS: In manometry, during straining the anal canal pressure decreased by 41.3 percent in G-I and increased by 168.6 percent in G-II, indicating a diagnosis of anismus for the second group. In US, during straining, the angle produced by the movement of the puborectalis muscle decreased from 63 ± 1.31 to 58 ± 1.509 degrees (P = 0.0135) in 23 of the 30 patients in G-I, indicating normal relaxation, and increased from 66 ± 0.972 to 72 ± 0.897 degrees (P = 0.0001) in 16 of the 19 patients in G-II, indicating anismus. The index of agreement between manometry and two dimensional anal ultrasonography was moderate: 77 percent (23/30) for G-I and 84 percent (16/19) for G-II. CONCLUSION: Two-dimensional dynamic anal ultrasonography showed similar results previously suggested by anal manometry at identifying patients with normal relaxation or paradoxical contraction.

CONTEXTO: O anismus é uma causa funcional frequente de evacuação obstruída. Caracteriza-se por sintomas de evacuação obstruída associada à presença de contração paradoxal dos músculos do assoalho pélvico. OBJETIVO: Avaliar o papel do ultrassom anorretal bidimensional dinâmico em identificar pacientes com contração paradoxal (anismus) ou relaxamento normal, comparando os resultado com medidas manométricas. MÉTODOS: Quarenta e nove mulheres com evacuação obstruída e com média de escore de constipação de 13.5 foram incluídas neste estudo prospectivo. Os pacientes foram divididos em dois grupos, de acordo com os achados da manometria: G-I - presença de relaxamento normal e G-II - paciente com contração paradoxal. Ultrassom anorretal bidimensional dinâmico avaliou e quantificou o movimento do músculo puborretal, utilizando o ângulo formado por duas linhas posicionada às 3 e 9 h na circunferência do transdutor convergindo na posição de 6 h, na borda interna do músculo puborretal. O ângulo diminui durante a evacuação em pacientes com relaxamento normal, mas aumenta em pacientes com anismus. A concordância entre as duas técnicas foi verificada utilizando-se o índice de Kappa. RESULTADOS: Na manometria, durante o esforço evacuatório, a pressão do canal anal reduziu 41.3 por cento no G-I e aumentou 168.6 por cento no G-II, indicando o diagnóstico de anismus no segundo grupo. No ultrassom anorretal bidimensional dinâmico, durante o esforço evacuatório, o ângulo do músculo puborretal diminuiu de 63 ± 1.31 para 58 ± 1.509 graus (P = 0.0135) em 23 dos 30 pacientes no G-I, indicando relaxamento normal, e aumentou de 66 ± 0.972 para 72 ± 0.897 graus (P = 0.0001) em 16 dos 19 pacientes no G-II, indicando anismus. O índice de concordância entre a manometria e o ultrassom anorretal bidimensional dinâmico foi moderado: 77 por cento (23/30) para o G-I e 84 por cento (16/19) para o G-II. CONCLUSÃO: Ultrassonografia anal bidimensional dinâmica demonstrou resultados similares aos previamente sugeridos pela manometria anorretal na identificação de pacientes com relaxamento normal ou contração paradoxal.

Associação de lesões anorretais em portadoras de infecção genital por HPV e neoplasia cérvico-uterina / Association between anorectal lesions in women with genital HPV infection and cervical-uterine neoplasia

OBJETIVOS: Diagnosticar a presença do HPV anorretal em portadoras dessa afecção no trato genital inferior, através do exame coloproctológico com anuscopia de alta resolução. MÉTODOS: Estudo observacional e transversal realizado através de um protocolo de pesquisa, no Hospital Universitário da UFAL de Fevereiro a Julho de 2008, analisando 57 mulheres com diagnóstico prévio de infecção genital por HPV submetendo-as a uma avaliação através da anuscopia de alta resolução. RESULTADOS: A idade média variou de 31,2 anos, seis pacientes eram gestantes, 59,6 por cento cursaram apenas o 1º grau, 73,7 por cento tinham união estável; A idade média de menarca foi 12,6 anos e a sexarca de 17 anos. Em relação ao número de parceiros sexuais, 33,3 por cento tiveram 2 a 3 parceiros; 68,6 por cento apresentaram lesão intraepitelial genital de baixo grau (LGSIL), CONCLUSÕES: 89,5 por cento não apresentavam lesões e 10,5 por cento apresentavam através da anuscopia de alta resolução(AAR) lesões sub-clínicas perianal, vulvar e vaginal. É possível e viável ao especialista incorporar o exame de anuscopia de alta resolução para diagnóstico de HPV ano-retal na forma subclínica à sua rotina, já que é de simples execução, barato e a doença acomete pacientes sem lesões visíveis ao exame proctológico.

AIM: To diagnose the presence of anorectal HPV in women with lower genital tract lesions, through rectal examination with High Resolution Anuscopy. METHODS: Observational, transversal study conducted by a research protocol in the Hospital Universitário Prof. Alberto Antunes (HUPAA/UFAL) from February to July 2008, examining 57 women with a previous diagnosis of genital HPV infection by subjecting them to an assessment by High Resolution Anuscopy. RESULTS: The mean age ranged from 31.2 years, six patients were pregnant women, 59.6 percent had finished elementary school, 73.7 percent were in a stable union with a partner, the average age of menarche was 12.6 years and 17 years for the first intercourse. Regarding the number of sexual partners, 33.3 percent had 2 to 3 partners, 68.6 percent had low grade squamous intraepithelial lesion (LGSIL), CONCLUSIONS: 89,5 percent had no lesions and 10,5 percent had subclinical perianal, vulvar and vaginal lesions. It is possible and feasible to the professionals incorporate the High Resolution Anuscopy for diagnosis of HPV in anorectal subclinical lesions to their routine, it is simple,inexpensive and mainly because the disease affects patients with no visible lesions to the anorectal examination.

Cáncer cérvico uterino y verrugas ano-genitales: Su relación / Cervix cancer and anus-genital warts: Its relation

Se realizó un estudio descriptivo de cohorte para determinar la relación entre el cáncer cérvico uterino y las verrugas ano-genitales. Se tomó como universo de estudio a todas las pacientes con el diagnóstico de cáncer cérvico uterino que acudieron a consulta de patología de cuello del Hospital Materno Provincial «Ana Betancourt de Mora¼, de Camagüey desde el 1ro de febrero de 2005 hasta el 31 de marzo de 2006. Se creó una consulta especializada para la selección de los pacientes. De un total de 142 pacientes se obtuvo una muestra de 100 con el diagnóstico de cáncer cérvico uterino con más de 18 años de edad, se les aplicó una encuesta según criterio de expertos y los resultados se analizaron por medios automáticos. Alrededor de la octava parte de las pacientes refirieron antecedentes de haber padecido de verrugas ano-genitales, la tercera parte las presentaban clínicamente y aproximadamente la décima parte de sus parejas sexuales refirieron este antecedente. El tiempo de evolución de las lesiones de 12 meses y más fue el más referido en relación con el diagnóstico de cáncer cérvico uterino. En la colposcopía predominó la vascularización atípica En la citología orgánica, las dos terceras partes de las pacientes presentaron positividad al PVH y predominó el diagnóstico de NIC I y NIC II. El resultado histológico de carcinoma epidermoide microinfiltrante al igual que la etapa clínica 1 fueron los más diagnosticados.

A cohort descriptive study to determine the relation between cervix cancer and the anus-genital warts was performed. It was taken as universe of study to all patients with diagnosis of cervix cancer who were attended in the cervix pathology consultation at «Ana Betancourt de Mora¼ Provincial Maternal Hospital, of Camagüey from February 1st, 2005 to March 31st, 2006. An specialized consultation for the selection of patients was created. Out of 142 patients a sample of 100 was obtained, diagnosed with cervix cancer with more than 18 years-old, a survey according to expert criterion was applied and results were analyzed by automatic means. About the eighth part of the patients referred antecedents of been afflicted with anus-genital warts, the third part presented clinically and approximately the tenth part of their sexual couples referred this antecedent. The evolution time of the lesions in 12 months and more was the most referred in relation to the diagnosis of cervix cancer? In colposcopy dominated the atypical vascularization. In the organic cytology, the two third parts of the patients presented positive PVH and dominated the diagnosis of NIC I and NIC II. The histological result of microinfiltrating squamous cell carcinoma as well as the clinical stage 1 was the most diagnosed.