Hidradenitis suppurativa / Maladie de Verneuil

Hidradenitis Suppurativa. Verneuil disease or hidradenitis suppurativa (HS) chronic, inflammatory, recurrent debilitating disease develops after puberty, with cutaneous and sub-cutaneous painfull nodules in the apocrine sweat glands regions (axillary inguinal and ano genital regions). Prevalence is 1% in Europe. Quality of life may be seriously impaired. HS is associated wtih over-weight, smoking, metabolic syndrome and some times with other inflammatory diseases (Crohn's colitis, spondylarthropathy). Main mechanism is occlusion of the hair follicule followed by lympho- histiocytic inflammation. A multi modal approach is advocated for treatment of inflammation with antibiotics and biologics. Surgery is useful in treatment of fibrotic lesions, singles or multiples fistulating nodules. Adjuvant care for metabolic syndrom, overweight, smoking is also recommended. Clinical scores and patients related outcomes are useful to evaluate treatments.

Maladie de Verneuil. La Maladie de Verneuil (MV) ou hidradénite suppurative (HS) est une affection cutanée chronique, inflammatoire, récidivante, invalidante , apparaissant après le puberté, faite de lésions douloureuses cutanées et sous-cutanées dans les territoires des glandes apocrines (creux axillaire, creux inguinaux et région périano-génitale ). Sa prévalence est de 1 % en Europe. HS est une des affections cutanées chroniques qui altère profondément la qualité de vie des patients. Elle est associée au surpoids, au tabac, à un syndrome métabolique, parfois à d'autres maladies inflammatoires (maladie de Crohn, spondylarthropathies) . Le primum movens est l'occlusion du follicule pileux à l'origine d'une réaction inflammatoire lympho ­ histiocytaire. Une approche thérapeutique multi modale est parfois nécessaire pour lutter contre l'inflammation par l'utilisations d'antibiotiques et d'anti inflammatoires, et contre la fibrose et les nodules isolés ou clapiers suppuratifs par la chirurgie. Une prise en charge adjuvante des troubles métaboliques , du surpoids et du tabagisme est également recommandée. L'efficacité des traitements est au mieux être évaluée par des scores et l'auto appréciation des patients.

Defecation disorders: a French population survey.

PURPOSE: Despite frequent occurrence, functional defecation disorders and related conditions have been infrequently reported in population studies. This study was designed to assess symptoms, lifestyle-behavioral changes, and medical care seeking related to functional defecation disorders in a large household community survey. METHODS: A large household community survey was conducted in 10,000 individuals aged 15 years or older. A mailed questionnaire was used to assess ten common anorectal complaints; frequency, association, impact on quality of life, and medical care seeking were quantified. RESULTS: Evaluation was obtained in 7,196 patients (3,455 males). During the previous 12-month period, 2,097 patients (29.1 percent) experienced functional defecation disorders: outlet constipation and fecal incontinence were reported in 22.4 and 16.8 percent respectively. Compared with patients with no anorectal complaint, patients with functional defecation disorders had a different gender status (females, 63.3 vs. 47.6 percent; P<0.01). Based on symptom severity, functional defecation disorders were perceived as the main anorectal complaint in 1,192 patients. In this group, emptying difficulties, unsatisfied defecation, gas, and fecal incontinence occurred at least once per month in 71.6, 56.1, 77.9, and 49 percent respectively: 66.6 percent with outlet constipation and 85.6 percent with incontinence revealed impairment in quality of life. Incontinent patients more frequently avoided medical care than those complaining of outlet constipation (67.4 vs. 46.4 percent; P<0.01). CONCLUSIONS: Functional defecation disorders concerns at least one of four French individuals. Outlet constipation and fecal incontinence frequently occur in association. Despite a low rate of patients seeking care, symptoms often are severe and related to quality of life impairment.

Is routine pathologic evaluation of hemorrhoidectomy specimens necessary?

AIM: To confirm that systematic histological study of hemorrhoidectomy specimens is useless, as is proposed by the French Society of Coloproctology (Société Nationale Française de Colo-Proctologie) under the sponsorship of the French National Health Accreditation and Evaluation Agency (Agence Nationale d'Accréditation et d'Evaluation en Santé). METHODS: Retrospective histological analysis of hemorrhoidectomy specimens obtained in a coloproctology unit between January 1, 1985 and December 31, 2001. RESULTS: We found 56 histological abnormalities (0.69%) among 8153 hemorrhoidectomy specimens considered normal at gross examination, with three cases of intraepithelial neoplasia of the anal canal (0.04%) and four cases of severe dysplasia (0.05%). Specimens associated with anal fissure (N = 906) or suppuration (N = 610) did not display more histological lesions. For all patients, the initial surgical resection prevented recurrence. CONCLUSION: Routine pathological evaluation of hemorrhoidectomy specimens is not useful and is expensive. All operating procedures in proctology should reflect this attitude. It is nevertheless advisable to select for gross and microscopic evaluation any suspicious areas noticed at the preoperative examination or during the procedure.