Intraoperative High-Resolution Anoscopy: A Minimally Invasive Approach in the Treatment of Patients with Bowen's Disease and Results in a Private Practice Setting

2007 ◽  
Vol 73 (12) ◽  
pp. 1279-1283 ◽  
Author(s):  
Alice P. Chung ◽  
David B. Rosenfeld
Keyword(s):  
High Resolution ◽  
Minimally Invasive ◽  
Pap Smear ◽  
Community Setting ◽  
Intraepithelial Neoplasia ◽  
Patient Characteristics ◽  
Hiv Positive ◽  
High Morbidity ◽  
Invasive Approach ◽  
Hiv Negative

Anal intraepithelial neoplasia III (AIN III) is a risk factor for anal cancer with poor curative results and high morbidity. High-resolution anoscopy (HRA) is a minimally invasive means of identifying and treating AIN III early. We retrospectively reviewed HRA in the treatment of AIN III in a community setting. From January 2002 through November 2005, 76 patients with AIN III diagnosed by anal Pap smear, colposcopy, or biopsy underwent HRA for diagnosis and treatment. Twenty-one patients with AIN III on initial HRA underwent follow-up HRA for reassessment and treatment at 6 months. Recurrence/persistence of disease was recorded and compared with patient characteristics. Of 21 patients with repeat HRA, four were HIV-negative and 17 were HIV-positive. Twelve of 21 (57%) had intraanal recurrence/persistence; nine of 21 (43%) had no AIN III. Eleven (92%) with recurrence were HIV-positive; one (8%) was HIV-negative. Three (75%) HIV-negative patients had no recurrence/persistence; one of four (25%) had recurrence; and 11 of 17 (65%) HIV-positive patients had persistence of disease. HRA is an alternative tool to treat AIN III and can be performed in a community setting yielding results comparable to the university setting. As the prevalence of AIN III increases, it will be more important for community surgeons to treat AIN III with HRA.

scholarly journals Screening of HIV sero positive women for cervical abnormalities

2018 ◽  
Vol 7 (8) ◽  
pp. 3222
Author(s):  
Meenakshi B. Chauhan ◽  
Sushila Chaudhary ◽  
Sunita Singh ◽  
Manasi Juneja ◽  
Smiti Nanda
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Intraepithelial Neoplasia ◽  
Developed Countries ◽  
Hiv Positive ◽  
Pap Smears ◽  
Cross Sectional ◽  
Age Related ◽  
Precancerous Stage ◽  
Hiv Negative

Background: Cancer cervix is a leading cause of death among women worldwide. Detection of cervical cancer in precancerous stage is 100% curable. Screening with Pap smear has reduced mortality by cervical cancer in developed countries many folds. The objective of the study is to determine prevalence of Cervical Intraepithelial Neoplasia (CIN) in HIV infected women and observe for associated lower genital infections and their correlation with CD4 counts.Methods: The present study is a cross-sectional observational study conducted at PGIMS, Rohtak, Haryana for a period of 18 months. 150 HIV patients and 150 age related control cases were taken. Pap smears were taken and analyzed for cervical abnormalities and genital infections.Results: Of the 300 Pap smear 22 (7.3%) has squamous intraepithelial abnormalities and 278 (92.7%) negative for intra epithelial abnormalities. Prevalence of cervical intraepithelial abnormities among HIV positive 12% while among HIV negative it is 2.7%. Cervical intraepithelial abnormalities were found in 40% and 3.5% of patients with CD4 count <200 and >200 respectively.Conclusions: HIV increases the risk of cervical abnormalities. Frequent screening of these patients for cervical cancer is needed.

scholarly journals Morphometric analysis of dendritic cells from anal mucosa of HIV-positive patients and the relation to intraepithelial lesions and cancer seen at a tertiary health institution in Brazil

2011 ◽  
Vol 26 (6) ◽  
pp. 521-529 ◽  
Author(s):  
Adriana Gonçalves Daumas Pinheiro Guimarães ◽  
Roberto Moreira da Silva Junior ◽  
Oscar Tadeu Ferreira da Costa ◽  
Ivan Tramujas da Costa e Silva ◽  
Felicidad Santos Gimenez ◽  
...  
Keyword(s):  
Dendritic Cells ◽  
Viral Load ◽  
Intraepithelial Neoplasia ◽  
Hpv Infection ◽  
Relative Volume ◽  
Significant Rise ◽  
Anal Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
Hiv 1 ◽  
Hiv Negative

PURPOSE: To morphometrically quantify CD1a+ dentritic cells and DC-SIGN+ dendritic cells in HIV-positive patients with anal squamous intraepithelial neoplasia and to evaluate the effects of HIV infection, antiretroviral therapy and HPV infection on epithelial and subepithelial dendritic cells. METHODS: A prospective study was performed to morphometrically analyze the relative volume of the dendritic cells and the relationship between anal intraepithelial neoplasia and cancer in HIV-positive patients from the Tropical Medicine Foundation of Amazonas, Brazil. All patients were submitted to biopsies of anorectal mucosa to perform a classic histopathological and immunohistochemical analysis, employing antibodies against CD1a and DC-SIGN for the morphometric quantification of dendritic cells. RESULTS: HIV-negative patients displayed a CD1a DC density significantly higher than that of HIV-positives patients (3.75 versus 2.54) (p=0.018), and in patients with severe anal intraepithelial neoplasia had correlated between DC CD1a density with levels of CD4 + cells (p: 0.04) as well as the viral load of HIV-1 (p: 0.035). A not significant rise in the median density of CD1a+ DC was observed in the HIV positive/ HAART positive subgroup compared to the HIV positive/ HAART negative subgroup. The CD1a+ DC were also significantly increased in HIV-negative patients with anorectal condyloma (2.33 to 3.53; p=0.05), with an opposite effect in HIV-positive patients. CONCLUSIONS: Our data support an enhancement of the synergistic action caused by HIV-HPV co-infection on the anal epithelium, weakening the DC for its major role in immune surveillance. Notoriously in patients with severe anal intraepithelial neoplasia, the density of CD1a+ epithelial dendritic cells was influenced by the viral load of HIV-1. Our study describes for the first time the density of subepithelial DC-SIGN+ dendritic cells in patients with anal severe anal intraepithelial neoplasia and points to the possibility that a specific therapy for HIV induces the recovery of the density of epithelial DC.

Prevalence and predictors of high-grade anal intraepithelial neoplasia in a community-based sample of homosexual men

Sexual Health ◽  
2012 ◽  
Vol 9 (6) ◽  
pp. 574 ◽  
Author(s):  
Richard J. Hillman ◽  
Marina T. van Leeuwen ◽  
Claire M. Vajdic ◽  
Leo McHugh ◽  
Garrett P. Prestage ◽  
...  
Keyword(s):  
High Risk ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
Homosexual Men ◽  
High Grade ◽  
Community Based ◽  
Cytological Abnormalities ◽  
Hiv Negative ◽  
Hiv Positive Men

Background We report the prevalence and predictors for high-grade anal intraepithelial neoplasia (HGAIN) in community-based cohorts of HIV-negative and HIV-positive homosexual men in Sydney, Australia. Methods: A cross-sectional study of consecutive participants in both cohorts was performed in 2005 (204 HIV-negative and 128 HIV-positive men). Anal swabs collected by a research nurse underwent cytological analysis, using the ThinPrep procedure, and human papillomavirus (HPV) testing. Participants who had cytological abnormalities other than low-grade squamous epithelial lesions (SIL) were referred for high resolution anoscopy (HRA). Results: A total of 114 men had cytological abnormalities (24.3% of HIV-negative and 57.5% of HIV-positive men, odds ratio (OR) = 4.21, 95% confidence interval (CI) 2.57–6.90). However, only three (2.3%) HIV-positive men and no HIV-negative men had high-grade SIL on anal cytology. Seventy-seven men were referred for HRA, of whom 63 (81.8%) attended. Histologically confirmed HGAIN was detected in 21 (33.3%). The prevalence of HGAIN was higher in HIV-positive men (10.8%) than in HIV-negative men (5.0%, OR = 2.29, 95% CI 0.93–5.63, P = 0.071). HGAIN was not related to age but was strongly associated with the detection of high-risk types of anal HPV (OR = 10.1, 95% CI 1.33–76.2) rather than low-risk types (OR = 1.97, 95% CI 0.74–5.25). Conclusion: HGAIN was prevalent in homosexual men across all age groups and was more than twice as common in HIV-positive men compared with HIV-negative men. The presence of high-risk anal HPV was highly predictive of HGAIN.

Cervical intraepithelial neoplasia recurrence after conization in HIV-positive and HIV-negative women

2008 ◽  
Vol 104 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Maria Inês Lima ◽  
Alexandre Tafuri ◽  
Angela C Araújo ◽  
Luiza de Miranda Lima ◽  
Victor Hugo Melo
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
Hiv Negative

14. Natural history of high-grade squamous intraepithelial lesions (HSIL) in homosexual men: early evidence from the Study of the Prevention of Anal Cancer (SPANC)

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 576 ◽  
Author(s):  
Andrew E. Grulich ◽  
Fengyi Jin ◽  
I. Mary Poynten ◽  
Jennifer Roberts ◽  
Annabelle Farnsworth ◽  
...  
Keyword(s):  
Natural History ◽  
Anal Cancer ◽  
Cochrane Review ◽  
Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
Homosexual Men ◽  
National Guidelines ◽  
Anal Swab ◽  
History Of ◽  
Hiv Negative

Background Screening for the anal cancer precursor HSIL is not recommended in national guidelines. A recent Cochrane review of HSIL treatment concluded there is no evidence of efficacy. In this context, we aimed to describe the natural history of anal HSIL, and association with human papillomavirus (HPV), in a community-recruited cohort of Australian homosexual men. Methods: The SPANC study is a three-year prospective study in men aged ≥35 years. At each visit, men undergo an anal swab for cytology and HPV genotyping (Roche Linear Array), followed by high-resolution anoscopy-aided biopsy. Anal HSIL is defined as having either anal intraepithelial neoplasia grade 2/3 on histology and/or HSIL/ASC-H on cytology. Results: Among 342 men recruited by March 2013, median age was 49 with 29% HIV positive. At baseline, prevalence of anal HSIL was 50% and 44% in the HIV-positive and HIV-negative groups, respectively (P = 0.303). Among those without HSIL at baseline, HSIL incidence was 28/100 person-years in both the HIV-positive and HIV-negative groups (P = 0.920). Among those with HSIL at baseline, the incidence of change to non-HSIL was 41 and 43/100 person-years (P = 0.851). Men with anal HPV16 at baseline were more likely to develop incident HSIL (57 vs 23/100 person-years, P = 0.010), and less likely to change to non-HSIL (18 vs 61/100 person-years, P = 0.001). Conclusions: Anal HSIL was highly prevalent in these homosexual men. Both incidence of HSIL and change to non-HSIL were common, and were closely associated with HPV16 status. HPV16 positivity may identify men with HSIL at higher risk of anal cancer.

Performance of cytology and colposcopy in diagnosis of cervical intraepithelial neoplasia (CIN) in HIV-positive and HIV-negative women

Cytopathology ◽  
2001 ◽  
Vol 12 (2) ◽  
pp. 84-93 ◽  
Author(s):  
M. Branca ◽  
E. Rossi ◽  
M. Alderisio ◽  
G. Migliore ◽  
P. L. Morosini ◽  
...  
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Intraepithelial Neoplasia ◽  
Hiv Positive ◽  
Hiv Negative

Citrobacter freundiicausing pharyngitis and secondary retropharyngeal abscess with intrathoracic extension to the diaphragm: minimally invasive management of a rare case

2010 ◽  
Vol 124 (5) ◽  
Author(s):  
A Trinidade ◽  
V Sekhawat ◽  
Z Andreou ◽  
J Meldrum ◽  
S Kamat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Head And Neck ◽  
Clinical Course ◽  
Retropharyngeal Abscess ◽  
Morbidity Rate ◽  
Suction Catheter ◽  
High Morbidity ◽  
Pharyngeal Wall ◽  
Invasive Approach ◽  
High Morbidity Rate

AbstractIntroduction:Citrobacter freundiiis a rare but potentially aggressive cause of pharyngitis which may progress to retropharyngeal abscess with diaphragmatic extension.Objective:To raise awareness of: (1) citrobacter as a potential cause of head and neck infection, including retropharyngeal abscess; (2) a novel surgical approach to draining such an abscess; and (3) citrobacter's particular biological properties which may affect the clinical course.Method:Case report.Results:The abscess was drained via a minimally invasive posterior pharyngeal wall incision and placement of a suction catheter into the mediastinum through this incision. Residual intrathoracic collections were drained by the cardiothoracic team via percutaneous aspiration. The patient made a full recovery.Conclusion:Early recognition of citrobacter head and neck infections, an awareness of the peculiarities of the clinical course of such infections, and timely surgical intervention can prevent catastrophic outcomes. A minimally invasive approach to mediastinal collections can be considered as a viable alternative to open thoracotomy, which carries a high morbidity rate.

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