Proctoscopy should be mandatory in men that have sex with men with external anogenital warts.

INTRODUCTION: The aim of this study was to evaluate anal pathology in men having sex with men (MSM) seen at our proctology outpatient clinics. METHODS: The charts of 74 MSM treated by the author between January 2002 and April 2006 were reviewed. RESULTS: Three of 74 patients (4%) had proctitis and 96% had anogenital condylomata acuminata (warts). 49 out of 71 (69%) had external anogenital as well as intra-anal warts and 13 (18%) had only intra-anal warts. In 14 an intra-anal dysplasia and in 2 patients intra-anal verrucous carcinomas were detected. The average duration of disease before referral to our institutions was more than 9 months. Half of the patients were previously treated for anogenital warts with ointments and suppositories at other institutions, including 17 that were "treated" with ointments and/or suppositories for hemorrhoids prescribed by family physicians. The patients mostly had widespread disease and sixty-nine of them required surgery. In the follow-up period there was no recurrence of warts and only itching was observed in 31 (44%) patients. Therapy with imiquimod was introduced for 3 months in twenty-two cases with intra-anal dysplasia. No major side effects were noticed despite intra-anal use. CONCLUSION: Proctoscopy and histological examination of intra-anal lesions in cases of external anogenital warts should be mandatory in MSM patients. I would like to encourage other physicians to use this approach, which enables detection of intra-anal warts, dysplasia, and even carcinoma in the asymptomatic stage.

Persistent high-risk sexual behaviour in men who have sex with men after symptomatic lymphogranuloma venereum proctitis.

In this brief paper, we report persistent high-risk sexual behaviour in a group of men who have sex with men (MSM) after symptomatic lymphogranuloma venereum (LGV) proctitis. Patient records were retrospectively studied and the number of newly acquired sexually transmitted disease (STD) was investigated. It was concluded that a high number of MSM (65%) contracted an STD relatively shortly after the diagnosis of LGV proctitis.

Rectal function following permanent prostate brachytherapy.

The purpose of this study was to review the clinical presentation, dosimetry, quality of life assessment, and management of proctitis following permanent prostate brachytherapy. The permanent prostate brachytherapy literature was reviewed using MEDLINE searches to ensure completeness. Rectal complications primarily consist of mild, self-limited proctitis. Rectal bleeding has been correlated with rectal dose. Dose response analysis has demonstrated that the risk of proctitis strongly correlates with the volume of rectal tissue exposed to a given dose. The reported incidence of rectal ulceration/fistula formation is < or = 1%. Constipation significantly increases the radiation dose to the rectum and potentially may contribute to brachytherapy-related morbidity. Quality of life assessments obtained via patient-administered instruments and by physician interview have illustrated that long-term bowel dysfunction is relatively uncommon. Significant bowel dysfunction following prostate brachytherapy is relatively rare, but rectal bleeding has been correlated with radiation dose. Routine post-brachytherapy biopsies of the anterior rectal wall are strongly contraindicated. The continued elucidation of the etiology of bowel dysfunction should result in refinements in implant technique and decreased brachytherapy-related morbidity.

Rectal function following brachytherapy with or without supplemental external beam radiation: results of two prospective randomized trials.

PURPOSE: To evaluate the effect of isotope and supplemental external beam radiation therapy (XRT) on brachytherapy-related rectal morbidity, using prospective, patient-administered quality of life (QOL) assessments. METHODS AND MATERIALS: Two hundred thirteen consecutive patients (median follow-up 22 months) were implanted on 2 prospective randomized brachytherapy trials evaluating the effect of isotope for low-risk patients and different doses of supplemental XRT for patients with higher risk features. Treatment-related rectal morbidity was evaluated by modified Radiation Therapy Oncology Group (RTOG) criteria and the multifactorial Rectal Function Assessment Score (R-FAS). Clinical, treatment and dosimetric parameters evaluated included patient age, diabetes, hypertension, tobacco consumption, clinical stage, prostate ultrasound volume, elapsed time since implant, hormonal manipulation, supplemental XRT, isotope, treatment planning volume, and values of the minimum dose received by 90% of the prostate gland (D90), the percent prostate volume receiving 100%, 150%, and 200% of the minimum peripheral dose (V(100/150/200)), rectal implant doses (V(75/100/125/150) and D(5/10/25/50)) and rectal XRT doses (D(5/10/25/50/75)). RESULTS: Using the RTOG instrument, rectal morbidity peaked at 1 month. The pre- and most recent postimplant median RTOG scores were 0 and 0, respectively. The pre- and postimplant R-FAS scores were 2.41 and 3.83, respectively. With time, the rectal scores for both instruments improved and approached baseline. In multivariate analysis, only the rectal dosimetry variable D5 predicted for bowel function when using the R-FAS instrument. No clinical, treatment, or dosimetric parameters predicted for bowel function when using the RTOG survey. No patient required surgical intervention for rectal complications. CONCLUSIONS: The multifactorial R-FAS elucidated fine gradations in bowel function of a severity less than RTOG Grade 3 morbidity. Of multiple clinical, treatment, and dosimetric parameters evaluated, only the minimum dose received by 5% of the rectum (D5) correlated with rectal dysfunction via the R-FAS instrument, while none of the evaluated parameters predicted for bowel dysfunction using the RTOG survey. Following permanent prostate brachytherapy, the ability to discern subtle changes in rectal function is dependent on the sensitivity of the survey instrument.

Psychological adjustment and patient information in inflammatory bowel disease: development of two assessment instruments.

Research on the psychological adjustments that patients must make in living with inflammatory bowel disease, symptomatic and life-disrupting chronic illnesses, has been difficult to interpret because no standard measurement instruments of known reliability and validity have been available. Two studies are presented on the construction, validation and cross-validation of the two instruments measuring patient information and psychological adjustment in inflammatory bowel disease. Both scales were shown to be reliable on the basis of internal consistency. Convergent validity of the psychological adjustment scale with measures of self-esteem and social competence and with a measure of public self-consciousness was demonstrated, as was discriminant validity along the dimension of social desirability. Assumptions underlying the scales are discussed, and research and clinical applications are suggested.

Colitis.

The disability caused by proctitis or colitis has been assessed among patients attending a hospital outpatient clinic. Although bowel frequency was a common and troublesome symptom, urgency of defaecation with a tendency to precipitate incontinence was a major factor limiting working life and leisure and social activities. Abdominal or rectal pain and lassitude were the other main symptoms. In every aspect of life studied the disability was as great for patients with proctitis or distal colitis as for those with more extensive inflammation of the colon. As a result of symptoms about a fifth of the patients had a reduced earning capacity and quarter were restricted in their social or leisure activities even when symptoms were at their least bad. The social disability of proctitis or colitis may be underestimated because patients do not mention their fear of incontinence and because their complaint of lassitude does not always correlate with the apparent activity or extent of the disease.