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1996-02-26
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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
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).