[Flat, depressed and polypoid colorectal lesions: a comparative study using a index of histological advance]. / Lesiones planas, deprimidas y polipoides colorrectales: estudio comparativo utilizando un índice de avance histológico.

BACKGROUND: It has been described that the histological changes in flat and depressed colon lesions are more advanced than the ones in polypoid lesions. OBJECTIVES: To compare the histological findings in flat or depressed (non polypoid) and elevated (polypoid) colon lesions. To validate the use of a newly developed Histological Advance Index to compare results. MATERIALS & METHODS: Prospective observational study. Population in study consisted of adult patients programmed for an elective colonoscopy at a private endoscopy center in Lima- Perú. Two groups: 417 found to have non polypoid lesions (which included flat, depressed and lateral spreading tumors or LST), and 405 with polypoid lesions. RESULTS: Total of 8,248 patients, with 417(5%) in the non polypoid group; 368(4.5%) in the flat lesion group, 27(0.32%) in the depressed and 22 (0.26%) LSTs. According to our index, flat and polypoid lesions showed no difference in histological findings. LSTs had a more advanced histology and depressed lesions reached the highest index scores. Flat lesions were found more often in right colon compared with polypoid ones (31% vs 22%, p<0.01), with a higher percentage of serrated lesions (9% vs 2%, p<0.01) and high grade dysplasia (5% vs 3%, NS). In contrast, depressed lesions, showed high grade dysplasia in 3.7% (NS) but cancer in 18% (p<0.01) LSTs were found mainly in right colon and rectum, showing villous component in 23%(p< 0.01) and high grade dysplasia in 32%(p <0.01), but no cancer was found. CONCLUSIONS: Flat and polypoid lesions showed similar histological findings, but LSTs were found to have a higher prevalence of villous lesions and high grade dysplasia. Depressed lesions were found to have a higher prevalence of malignancy. Histological Advance Index proved to be a useful tool to compare groups and quantify differences. .

Epidemiology of transfusion-transmitted infections among multi-transfused patients in seven hospitals in Peru.

BACKGROUND: Transfusion-transmitted infections (TTIs) constitute a major health problem worldwide where routine screening of blood or blood products is improperly done, and where non-medical injecting medications and/or drug use are prevalent. Prevalence and risk factors vary by geographic location and by the specific TTI (including HIV-1, HBV, HCV and HTLV-I). OBJECTIVE: To determine the prevalence and risk factors associated with TTIs among a sample of multi-transfused adult patients in Peru. STUDY DESIGN: A cross-sectional multi-center study was conducted across seven major hospitals in Peru from February 2003 to September 2004. Self-reported behavior information (medical procedures, number of sexual partners, and drug use history) was analyzed, along with a review of exposure history from hospital medical records. Prevalences were calculated by TTI for different exposures, along with unadjusted and adjusted odds ratios for infection risk. RESULTS: Overall, 192 (54.7%) of 351 multi-transfused patients were found infected with one or more TTIs. Number of transfusion units, years of transfusion history (6 or more), and number of treatment facilities (2 or more) were associated with HCV infection. Hemodialysis history was a common risk factor associated with HBV, HCV and HTLV-I infection. HIV infection was associated only with total number of transfusion units received. CONCLUSIONS: High prevalences of HBV and HCV infection were found among Peruvian multi-transfused patients and were associated with a past history and number of blood transfusions, as well as with past hemodialysis procedures. TTIs continue to represent a significant public health problem in Peru. Continued vigilant attention to blood safety procedures, including universal screening and health care provider education, is recommended.

Lesiones planas, deprimidas y polipoides colorrectales: estudio comparativo utilizando un índice de avance histológico / Flat lesions, and polypoid colorectal depressed: a comparative study using a histologic progress index

ANTECEDENTES: Se ha descrito que las lesiones planas y deprimidas colorrectales, llamadas también no polipoides (LNP) tienen una histología más avanzada que las polipoides o protruidas (LP). OBJETIVOS: Comparar el grado de avance histológico de las LNP con el de las LP, a nivel del colon y recto. Validar el uso de un Índice de Avance Histológico (IAH) para objetivar estas diferencias. METODOLOGÍA: Estudio observacional, prospectivo, realizado en adultos programados a colonoscopía en un Centro Endoscópico privado de Lima- Perú. Dos grupos: 417 pacientes con LNP (planas, deprimidas y de crecimiento lateral o LST) y 405 pacientes con solo LP. RESULTADOS: 417/ 8,248 pacientes (5%) tuvieron LNP; 368 (4.5%) planas, 27(0.32%) deprimidas y 22(0.26%) LST. Según nuestro IAH, las lesiones planas y polipoides mostraron similar avance histológico. Las LST tuvieron una histología más avanzada y las deprimidas alcanzaron los valores más altos. Las lesiones planas tuvieron mayor tendencia que las polipoides a situarse en colon derecho (31% vs 22% p< 0.01), a presentar histología aserrada (9% vs 2% p< 0.01) y displasia de alto grado (5% vs 3% NS), pero menor tendencia al cáncer (0.2% vs 1% NS). Comparadas con las polipoides, las deprimidas tuvieron similar displasia de alto grado (3.7% /NS) pero una alta proporción de cáncer (18 % p < 0.01), mientras que las LST se localizaron sobre todo en colon derecho y recto, con componente velloso en 23% (p< 0.01) y displasia de alto grado en 32% (p< 0.01), pero no cáncer. CONCLUSIONES: Las lesiones planas mostraron un grado de avance histológico similar a las polipoides, pero las de crecimiento lateral si tuvieron una histología más avanzada y las deprimidas desarrollaron cáncer en una elevada proporción. El Índice de Avance Histológico fue una herramienta útil para comparar los grupos y resaltar sus diferencias.

BACKGROUND: It has been described that the histological changes in flat and depressed colon lesions are more advanced than the ones in polypoid lesions. Objectives: To compare the histological findings in flat or depressed (non polypoid) and elevated (polypoid) colon lesions. To validate the use of a newly developed Histological Advance Index to compare results. MATERIALS & METHODS: Prospective observational study. Population in study consisted of adult patients programmed for an elective colonoscopy at a private endoscopy center in Lima- Perú. Two groups: 417 found to have non polypoid lesions (which included flat, depressed and lateral spreading tumors or LST), and 405 with polypoid lesions. RESULTS: Total of 8,248 patients, with 417(5%) in the non polypoid group; 368(4.5%) in the flat lesion group, 27(0.32%) in the depressed and 22 (0.26%) LSTs. According to our index, flat and polypoid lesions showed no difference in histological findings. LSTs had a more advanced histology and depressed lesions reached the highest index scores. Flat lesions were found more often in right colon compared with polypoid ones (31% vs 22%, p<0.01), with a higher percentage of serrated lesions (9% vs 2%, p<0.01) and high grade dysplasia (5% vs 3%, NS). In contrast, depressed lesions, showed high grade dysplasia in 3.7% (NS) but cancer in 18% (p<0.01) LSTs were found mainly in right colon and rectum, showing villous component in 23%(p< 0.01) and high grade dysplasia in 32%(p <0.01), but no cancer was found. CONCLUSIONS: Flat and polypoid lesions showed similar histological findings, but LSTs were found to have a higher prevalence of villous lesions and high grade dysplasia. Depressed lesions were found to have a higher prevalence of malignancy. Histological Advance Index proved to be a useful tool to compare groups and quantify differences.