Anal intraepithelial neoplasia screening in patients with human immunodeficiency virus infection.

INTRODUCTION: the incidence of anal cancer has increased in recent years, making screening and early detection of anal intraepithelial neoplasia (AIN) a necessity in patients at risk. METHODS: a descriptive observational study of homosexual patients (MSM) or women with cervical intraepithelial neoplasia (CIN) III, with human immunodeficiency virus (HIV) infection, included in an AIN detection screening program was carried out between March 2016 and September 2019. RESULTS: we have performed 695 anal smears, 156 with results of LSIL (low-grade lesion) or HSIL (high-grade lesion) (22.4 %), and 116 high resolution anoscopy (HRA), 75.3 % of patients with altered cytology. We have 403 biopsies, being 84 % pathological, 197 biopsies of AIN I (49 %), 96 of AIN II and III (24 %), 44 condylomas (11 %) and the rest (16 %), normal mucosa. CONCLUSION: the high prevalence of premalignant lesions and the improvement in the staging of lesions after treatment recommend this protocol.

Results of a national survey on the use of stents for the treatment of colonic obstruction. / Resultados de una encuesta nacional sobre el uso de stent para el tratamiento de la obstrucción de colon.

INTRODUCTION: We distributed a survey in order to determine the current indications for the use of colonic stents to treat colonic obstruction in Spain and its compliance with international guidelines. METHODS: Descriptive study of a survey distributed by the Spanish Association of Surgeons (Asociación Española de Cirujanos), the Catalan Society of Surgery (Societat Catalana de Cirurgia) and the Spanish Society of Digestive Endoscopy (Sociedad Española de Endoscopia Digestiva). RESULTS: 340 valid responses were received: 25% from gastrointestinal specialists, and 75% from general surgeons. During the last year, 44.4% of respondents assessed between 10 and 20 COC. Of these, 52.2% indicated less than 5 stents/year, 75% of which were indicated as a prior step to preferential surgery and only 25% were performed with palliative intent. 55.3% of the participants reported knowing the official guidelines, and 64% of respondents would use the stent as a step prior to surgery in elderly patients with localized disease. 75.9% would place stents as palliative therapy in young patients with carcinomatosis, and 61.8% would use them in stage IV malignancies under treatment with chemotherapy. Only 18.1% knew of the risk of colon perforation after stent placement in patients undergoing treatment with antiangiogenics. CONCLUSIONS: In Spain, the indication for colonic stents is reserved for selected cases and varies according to the specialty and the years of experience of the respondent. The compliance with international guidelines of most respondents is moderate. It is important to insist on the high risk of perforation after angiogenics, which is unknown to most surgeons.

Aberrant single metastasis to the elbow from primary rectal cancer: a rare presentation.

Rectal adenocarcinoma usually metastasizes to the liver and lungs and when it has bone spread, it more frequently involves the vertebrae and pelvis. Thus, aberrant metastasis from a rectal adenocarcinoma to upper extremities with preservation of intra-abdominal organs is very uncommon. We present the case of an 80-year-old male patient with a diagnosis of adenocarcinoma of the rectum T4N1M1 with non-axial single bone metastases and with preservation of visceral organs. Anterior resection of rectum after neoadjuvant chemotherapy and radiotherapy were made. The bone metastasis received palliative radiotherapy and was not resected. The patient died 10 months after diagnosis. This clinical situation generally has a poor prognosis. When the patient complains of unusual bone pain it is necessary to suspect a malignant disease and even if extraordinarily rare, rectal cancer must be considered as a possible cause.

Resultados de una encuesta nacional sobre el uso de stent para el tratamiento de la obstrucción de colon / Results of a national survey on the use of stents for the treatment of colonic obstruction

INTRODUCCIÓN: Difundimos una encuesta con el objetivo de conocer las indicaciones actuales para la utilización del stent de colon para el tratamiento de la obstrucción colónica en España y su adecuación a las guías internacionales. MÉTODOS: Estudio descriptivo de una encuesta distribuida por la Asociación Española de Cirujanos, la Societat Catalana de Cirurgía y la Sociedad Española de Endoscopia Digestiva. RESULTADOS: Se recibieron 340 respuestas válidas, un 25% de médicos digestólogos, y el 75% de cirujanos generales. Durante el último año el 44,4% de los encuestados valoró entre 10 a 20 COC. Un 52,2% indicó menos de 5 stents/año, y de estos el 75% se indicó como paso previo a una cirugía preferente y solo el 25% se realizó con intención paliativa. Un 55,3% de los participantes refirió conocer las guías oficiales. El 64% de los encuestados utilizaría el stent como paso previo a cirugía en ancianos con enfermedad localizada. El 75,9% colocaría stent con fines paliativos en jóvenes con carcinomatosis, y un 61,8% los utilizaría en neoplasias estadio IV en tratamiento con quimioterapia. Solo un 18,1% conocía el riesgo de perforación de colon tras stent en pacientes en tratamiento con antiangiogénicos. CONCLUSIONES: En España la indicación del stent de colon se reserva para casos seleccionados y varía según la especialidad y los años de experiencia del encuestado. La adecuación a las guías internacionales para la mayoría de los encuestados es moderada. Es importante insistir en el alto riesgo de perforación tras angiogénicos, pues la mayoría de profesionales lo desconocen

INTRODUCTION: We distributed a survey in order to determine the current indications for the use of colonic stents to treat colonic obstruction in Spain and its compliance with international guidelines. METHODS: Descriptive study of a survey distributed by the Spanish Association of Surgeons (Asociación Española de Cirujanos), the Catalan Society of Surgery (Societat Catalana de Cirurgia) and the Spanish Society of Digestive Endoscopy (Sociedad Española de Endoscopia Digestiva). RESULTS: 340 valid responses were received: 25% from gastrointestinal specialists, and 75% from general surgeons. During the last year, 44.4% of respondents assessed between 10 and 20 COC. Of these, 52.2% indicated less than 5 stents/year, 75% of which were indicated as a prior step to preferential surgery and only 25% were performed with palliative intent. 55.3% of the participants reported knowing the official guidelines, and 64% of respondents would use the stent as a step prior to surgery in elderly patients with localized disease. 75.9% would place stents as palliative therapy in young patients with carcinomatosis, and 61.8% would use them in stage IV malignancies under treatment with chemotherapy. Only 18.1% knew of the risk of colon perforation after stent placement in patients undergoing treatment with antiangiogenics. CONCLUSIONS: In Spain, the indication for colonic stents is reserved for selected cases and varies according to the specialty and the years of experience of the respondent. The compliance with international guidelines of most respondents is moderate. It is important to insist on the high risk of perforation after angiogenics, which is unknown to most surgeons

Trombosis del ligamento redondo del hígado asociado a colangitis aguda / Thrombosis of the hepatic round ligament associated with acure cholangitis

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Cribado de neoplasia intraepitelial anal en pacientes con infección por virus de la inmunodeficiencia humana / Anal intraepithelial neoplasia screening in patients with human immunodeficiency virus infection

Introducción: la incidencia de cáncer anal ha aumentadoen los últimos años, por lo que el cribado y la detecciónprecoz de la neoplasia intraepitelial anal (AIN) en pacientesde riesgo son una necesidad.Métodos: se realizó un estudio observacional descriptivode pacientes homosexuales (HSH) o mujeres con neoplasiacervical intraepitelial grado III (CIN III), con infección porvirus de la inmunodeficiencia humana (PVIH), incluidos enun programa de cribado de detección de AIN entre marzode 2016 y septiembre de 2019.Resultados: se realizaron 695 citologías anales, 156 conresultados de lesión de bajo grado (LSIL) o lesión de altogrado (HSIL) (22,4 %), y 116 anoscopias de alta resolución(HRA), el 75,3 % de los pacientes con citología alterada. Sehan obtenido 403 biopsias, el 84 % de ellas patológicas; 197biopsias evidenciaron AIN I (49 %) y 96, AIN II y III (24 %); 44eran condilomas (11 %); y el 16 %, mucosa normal.Conclusión: la alta prevalencia de lesiones premalignas y lamejoría del estadiaje de las lesiones tras tratamiento recomienda dicho protocolo. (AU)

Intususcepción colo-cólica primaria como causa de oclusión intestinal / Primary colo-colic intussusception as cause of intestinal obstruction

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