Document 0675
 DOCN  M9620675
 TI    Anorectal surgery in human immunodeficiency virus-infected patients.
       Clinical outcome in relation to immune status.
 DT    9602
 AU    Consten EC; Slors FJ; Noten HJ; Oosting H; Danner SA; van Lanschot JJ;
       Department of Surgery, Academic Medical Centre, Amsterdam, The;
       Netherlands.
 SO    Dis Colon Rectum. 1995 Nov;38(11):1169-75. Unique Identifier : AIDSLINE
       MED/96060869
 AB    PURPOSE: Anorectal disease is commonly found in human immunodeficiency
       virus (HIV)-infected patients. The aim of this study was to determine
       the spectrum of anorectal disease, its surgical treatment, clinical
       outcome, and its relation to immune status. METHODS: Medical records of
       all HIV-infected patients with anorectal pathology that required
       surgical treatment from January 1984 to January 1994 were
       retrospectively reviewed. Patients were divided into five different
       groups: common anorectal pathology (hemorrhoids, polyps, Group A);
       condylomata acuminata (Group B); perianal sepsis (abscesses, fistulas,
       Group C); anorectal ulcers (Group D); malignancies (Group E). RESULTS:
       Eighty-three patients needed 204 surgical consultations (13 percent
       conservative, 87 percent operative) for 170 anorectal diseases.
       Fifty-one patients had multiple anorectal pathology. Operative
       intervention resulted in adequate wound healing and symptom relief in 59
       percent of patients, adequate wound healing without relief of symptoms
       in 24 percent of patients, and disturbed wound healing was related to
       type of anorectal disease (P < 0.001) and to preoperative
       CD4(+)-lymphocyte counts (P < 0.01). Disturbed wound healing and most
       insufficient immune status were encountered in Groups C, D, and E.
       Within these groups low CD4(+)-lymphocyte counts were a risk factor for
       disturbed wound healing (P = 0.004). Median postoperative survival was
       highest (4.7 years) in Group A, lowest (0.6 years) in Groups D and E,
       and related to type of anorectal disease (P = 0.0001). CONCLUSIONS: The
       spectrum of anorectal disease is complex. Type of anorectal disease is
       strongly related to immune status, wound healing, and postoperative
       survival.
 DE    Adult  Anus Diseases/*COMPLICATIONS/IMMUNOLOGY/*SURGERY  CD4 Lymphocyte
       Count  Female  Human  HIV Infections/*COMPLICATIONS/IMMUNOLOGY  Male
       Middle Age  Prognosis  Survival Analysis  Treatment Outcome  Wound
       Healing/IMMUNOLOGY/PHYSIOLOGY  JOURNAL ARTICLE

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