Is there a higher frequency of anal dysplasia and infection by human papillomavirus in Crohn's disease patients?

The aim of this study was to compare the frequency of dysplasia and human papillomavirus (HPV) infection in the anal canal of patients with Crohn's disease (CD) with a control group and assess whether there is a correlation between use of immunosuppressants and anal manifestation of CD. Patients with CD and control individuals were submitted to anal cytology and material collection for polymerase chain reaction (PCR). The cytology was classified as normal, atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade (HSIL). PCR was considered positive or negative according to virus presence or absence. A total of 117 patients were included (54 in the control group and 63 in the CD group, being 32 without and 31 with immunosuppressants). ASCUS and LSIL were found in 25.9 and 22.2% of control patients and 28.6 and 39.7% of CD patients. HPV was identified in 14.8% of the control group and 27% of the CD group. In CD patients, HPV was found in 37.5 and 16.1% of those without and with immunosuppressants, respectively. Patients with perianal involvement had 15.6% of PCR positivity. There was no statistical difference in dysplasia and infection by HPV between the groups. Use of immunosuppressants did not influence the result, but anal manifestation was inversely proportional to viral detection.

Is there a higher frequency of anal dysplasia and infection by human papillomavirus in Crohn's disease patients?

The aim of this study was to compare the frequency of dysplasia and human papillomavirus (HPV) infection in the anal canal of patients with Crohn's disease (CD) with a control group and assess whether there is a correlation between use of immunosuppressants and anal manifestation of CD. Patients with CD and control individuals were submitted to anal cytology and material collection for polymerase chain reaction (PCR). The cytology was classified as normal, atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade (HSIL). PCR was considered positive or negative according to virus presence or absence. A total of 117 patients were included (54 in the control group and 63 in the CD group, being 32 without and 31 with immunosuppressants). ASCUS and LSIL were found in 25.9 and 22.2% of control patients and 28.6 and 39.7% of CD patients. HPV was identified in 14.8% of the control group and 27% of the CD group. In CD patients, HPV was found in 37.5 and 16.1% of those without and with immunosuppressants, respectively. Patients with perianal involvement had 15.6% of PCR positivity. There was no statistical difference in dysplasia and infection by HPV between the groups. Use of immunosuppressants did not influence the result, but anal manifestation was inversely proportional to viral detection.

Diagnostic colonoscopy.

Colonoscopy is employed in prevention, diagnosis, follow-up and treatment of colorectal diseases. The technological advancement of colonoscopes and supplementary equipment, has broadened indications for colonoscopy. However, since it is an invasive method with potential complications and hazards it should be performed by specialists capable of preventing, recognizing and treating them. The authors report their personal experience with 1,234 colonoscopies. The most frequent indications were changes in bowel habits and rectal bleeding in 35.1% and 30.5% cases respectively. The patients were given 10% mannitol for bowel cleansing and inadequate bowel cleansing in only 15 (1.2%) so that the colonoscopy could not be completed. The overall incidence of perforation was 0.16%. Three hundred and one polypectomies were performed and two cases (0.75%) of bleeding were noted.

Polypectomies: colonic endoscopic resections.

The authors present their experience with 924 colonoscopic polypectomies in 549 patients. Postpolypectomy bleeding was 0.36% without perforations. Complications associated with the procedure are analyzed; evaluating the risk, diagnosis and treatment based on a survey of the literature and personal experience.

Orifice Diseases Project--experience of the "Hospital das Clínicas" University of São Paulo Medical Center in day-hospital of anorectal disease.

The treatment of malignant or benign colorectal pathologies that require more complex management are priorities in tertiary hospitals such as "Hospital das Clínicas" University of São Paulo Medical Center (HCFMUSP). Therefore, benign, uncomplicated orifice conditions are relegated to second place. The number of patients with hemorrhoids, perianal fistulas, fissures, condylomas and pilonidal cysts who seek treatment at the HFMUSP is very great, resulting in over-crowding in the outpatient clinics and a long waiting list for recommended surgical treatment (at times over 18 months). The authors describe the experience of the HCFMUSP over an eight-day period with day-hospital surgery in which 140 patients underwent surgery. Data was prospectively taken on the patients undergoing surgery for benign orifice pathologies including age, sex, diagnosis, surgery performed, immediate and late postoperative complications, and follow-up, 140 patients operated on over eight days were studied, 68 were males (48.75%) with ages ranging from 25 to 62 (mean 35.2 yrs.). Hemorrhoids was the most frequent condition encountered (82 hemorrhoidectomies, 58.6%), followed by perineal fistula (28 fistula repairs, 20.0%). The most common complication was headache secondary to rachianesthesia occurring in 9 patients (6.4%). One patient (0.7%) developed bleeding immediately PO that required reoperation. Mean follow-up was 104 days. Day-surgery characterized by quality care and low morbidity is feasible in tertiary public hospitals, permitting surgery for benign orifice pathologies on many patients within a short period of time.

[Colonoscopy: indications, contraindications and complications]. / Colonoscopia: indicações, contra-indicações e complicações.

The bioengeneering technological development associated with new medical information transformed colonscopy today in one of the most complete method of investigation on colorrectal diseases. The authors aim to describe the use of colonoscopy as a diagnostic and therapeutic method, its main indications and limitations. The wide utilization of colonoscopy as therapy is emphasized in the polipectomy, the identification of bleeding areas and the hemostasy. Some intervening facts are discussed as copious bleeding, perfuration and post polipectomy syndrome. Finally, the authors report the low morbidity and mortality rates in their personal experience with colonoscopy during the last decade.

[Villous and tubulovillous adenomas of the colon and rectum. Results in 30 patients]. / Adenomas vilosos e túbulo-vilosos do cólon e reto. Resultados observados em 30 casos.

UNLABELLED: Colorectal adenomas precede carcinomas as much as they become larger and present villous histology. Since colonoscopic polypectomy cannot remove all polyps, surgical options include local resection as well as segmental colectomy. Significant morbidity and high recurrence rates may occur following individual and polyp-related characteristics. This paper focuses the clinical aspects of colorectal tubulo-villous adenomas and the results of the surgical treatment. PATIENTS AND METHODS: Hospital charts from 30 patients who underwent surgical treatment of colorectal tubulovillous adenomas between 1980 and 1997 were retrospectively reviewed. RESULTS: Rectal bleeding, urgency and mucus discharge were the most frequent clinical findings. Proctologic examination (digital and rigid rectosigmoidoscopy) diagnosed the lesion for the majority of cases. Seventy per cent of the polyps were in the distal rectum and 60% were larger than 4 cm. Transanal resection was the surgical option for one half of the patients and segmental colectomy for the other. Fourty-two per cent of the polyps that were considered benign as result of preoperative biopsy showed malignant transformation when the whole polyp was examined. Recurrence rate was 26.7% and 6.7% for patients who underwent local resection and segmental colectomy respectively. Postoperative complication rate was similar for the two surgical groups. CONCLUSIONS: Recurrence may occur frequently after standard local resection. Preoperative biopsy examination has no role for the diagnosis of malignant transformation. Office proctologic examination diagnoses majority of colorectal polyps that may be elected for surgical resection.

[Colonoscopy as a diagnostic and therapeutic method in large intestine diseases. Results of 1715 exams]. / Emprego da colonoscopia como método diagnóstico e terapêutico das doenças do intestino grosso. Resultados observados em 1.715 exames.

Widespread use of colonoscopy in clinical practice results from the continuous progress of the techniques developed for exam completion and from the therapeutic perspective for several colorectal conditions. This paper analyses in a retrospective basis the results associated to the employment of fibrocolonoscopy between 1984 and 1995 at Discipline of Coloproctology from the University of São Paulo School of Medicine. For this period, 1,715 exams were realized. More than 50% of the patients were between the 50th and 70th decade. Habit change of hemorrhage were indications for the exam in more than 35%. Inflammatory bowel disease and cancer follow-up were indications, respectively, in 18% and 16%. "Express mannitol" bowel prep resulted satisfactory in more than 97% but precluded complete exam for seven (0.4%) patients. In 42.5%, colonoscopic examination was normal. Polyps were found in 248 (14.5%) patients for whom 376 polypectomy procedures were done successfully. Endoscopists could not reach the cecum in 68 (3.9%) patients. Incidence of hemorrhage and perforation was nill for this series. Authors conclude that fibrocolonoscopy remains as a safe and efficient method for the diagnosis and treatment (polypectomy) of common colorectal conditions.

[Surgical treatment outcome of hemorrhoidal in 475 patients]. / Resultados do tratamentro cirúrgico da doença hemorroidária em 475 doentes.

Despite feared by patients and reserved for the minority of patients suffering from hemorrohoids, hemorrhoidectomy remains as the most effective approach to this condition. To analyse results from 475 hemorrhoidectomies performed at University of São Paulo Hospital das Clínicas between 1984 and 1995, a retrospective chart review regarding gender, age, associated anorectal conditions, surgical technique, complications and their management and follow-up was addressed. Two hundred and seven (43.6%) were male. Age between fourth and sixth decades were observed for 70.8%. Associated anorectal conditions were diagnosed in 18.9%. Chronic anal fissure was the commonest one. Milligan-Morgan operation was performed in the majority of patients (91.2%) and Ferguson technique in 6.7%. There were no intraoperative complications postoperative complications occurred in 38 (8%) patients regardless of employed surgical technique. Urinary retention was the commonest postoperative complication. Mean follow-up was 5.8 years for 70% of patients. Surgical hemorrhoidectomy remains as a treatment with excellent results in the management of hemorrhoid disease for selected patients. Produces erradications of the disease in all cases in spite of low morbidity.

[Results of the surgical treatment of non-complicated pilonidal disease]. / Resultados do tratamento cirúrgico de cisto pilonidal não-complicado.

In spite of the high incidence of pilonidal disease at young population and prolonged disabling period that it demands, colorectal surgeons have not reached consensus about etiology or best treatment for this condition. The authors intend to analyse results from 154 cases operated on at HCFMUSP through a retrospective chart analysis regarding patients' sex, age and race, operative technique, complications and recurrence. Half patients were male. Eighty-three percent were between 11 and 30 yr-old. Incision and curettage was offered to 74.7% of the patients. Excision technique was used in 25.3%. In patients who underwent excision technique, there were no recurrences and a cicatrization defect was diagnosed in 2 (5.1%) patients. For patients who underwent incision and curettage, recurrence was 3.5% and cicatrization defect was seen in 1 (0.9%) case. Excision or incision plus curettage techniques seem to be both effective for treatment of chronic pilonidal disease although the former may produce healing defect more commonly. Patients who present with complex lesions may benefit from excisional techniques associated to skin or myocutaneous flaps in a first attempt instead of conservative approaches.

[Chronic anal fissure: results of the surgical treatment of 220 patients]. / Fissura anal crônica: resultados do tratamento cirúrgico em 220 doentes.

Since results from non-surgical procedures designed for treatment of chronic anal fissure are still controversial, sphincterotomy remain as the "state of the art" therapy for this condition. In a retrospective basis, the authors intend to review results from treatment of chronic anal fissure in 220 patients who underwent surgical procedure between 1984 and 1995. Data from chart review included age, sex, location of the lesion at the canal anal, associated anorectal disease, delivered surgical technique and complications. Seventy per cent of the patients were male. Mean age was 37.1 years. Fissure was located at the posterior midline in 86.1%. Associated anorectal conditions occurred in 41.4%. Fissurectomy plus posterior sphincterotomy was the treatment of choice in 84.1%. Complications occurred in 5 (2.3%) cases. There were no incontinent patients. Mean follow-up was 2.6 years. The authors conclude that partial internal anal sphincter section produces excellent results in treatment of chronic anal fissure. Posterior sphincterotomy may persist effective and safe since continence impairment was not identified in the present study.

[The management of acute pancreatitis in pregnancy--the coadjuvant role of parenteral feeding]. / Manejo da pancreatite aguda da gravidez--o papel coadjuvante da nutrição parenteral.

Acute pancreatitis in pregnancy is not a frequent condition: only a few hundred cases have been published in the literature. Its diagnosis can be misguided by clinical manifestations of the pregnancy itself, and by the delay in ordering the required diagnostic tests. These facts may contribute to the serious prognosis of this disease, which in the past had a mortality of up to 20%. The treatment recommended is conservative. A surgical intervention in the event of biliary lithiasis is best to be postponed till after delivery. Parenteral alimentation can be helpful because of its effects in the promotion of pancreatic rest with simultaneous improvement of the nutritional conditions of the mother and the fetus.