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Phakathi BP, Basson G, Karusseit VOL, Olorunju SAS, Mokoena T. The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study. Int J Surg 2016; 34:109-115. [PMID: 27573692 DOI: 10.1016/j.ijsu.2016.08.520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 08/16/2016] [Accepted: 08/24/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Breast cancer is the most common cancer of women in the world. Twenty-five percent of people living with the human immunodeficiency virus (HIV) reside in South Africa. The coincidence of breast cancer and HIV infection is therefore common in South Africa. There is a perception that systemic and local surgical complications are more common in HIV-infected patients, and that these patients tolerate chemo- and radiotherapy poorly. AIM The aim of the study was to determine the effect of HIV infection on the management of breast cancer by comparing HIV-infected to -noninfected patients. The outcomes of surgery and adjuvant/neoadjuvant therapy were examined in these groups. METHOD The study was performed at the Steve Biko Academic Hospital, Pretoria, South Africa, during 2009-2014. Patients scheduled for surgery for breast cancer were recruited prospectively and their HIV status was determined. All patients were managed according to standard guidelines for breast cancer. Patients were followed up for 30 days and local and systemic surgical complications documented. Completion or non-completion of courses of chemo- and radiotherapy, and reasons for non-completion were documented. HIV-infected and -noninfected patients respectively were grouped, and compared statistically. RESULTS One hundred and sixty patients (31 HIV-infected) were included. The frequency of surgical complications did not differ significantly between HIV-noninfected and infected patients (p = 0.08), more occurring in the HIV-noninfected patients. The risk ratio of HIV infection for surgical complications was 0.20 and the odds ratio 0.23. The completion of courses of chemo- and radiotherapy did not differ between the HIV-infected and -noninfected patients. Twenty-five of 27 HIV-infected patients (93%) and 100 of 113 HIV-noninfected patients (94%) completed their courses of chemotherapy (p = 0.68). Twelve of 14 HIV-infected patients (86%) and 40 of 41 HIV-noninfected patients (98%) completed their courses of radiotherapy (p = 0.16). CONCLUSION These results suggest that HIV-infected patients with breast cancer do not experience more treatment-related complications and can be treated according to standard guidelines.
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Affiliation(s)
- Boitumelo P Phakathi
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Gerhard Basson
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Victor O L Karusseit
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
| | - Steve A S Olorunju
- Biostatistics Unit, South African Medical Research Council, South Africa
| | - Taole Mokoena
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
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Abstract
Highly active antiretroviral therapy has dramatically reduced morbidity and mortality among patients who are HIV-positive. A retrospective review of the authors' data separated subjects into cohorts based on HIV status and matched them for age and gender. The authors' data reveal a higher fraction of venous ulcers compared with a lower fraction of pressure ulcers in the seropositive population.
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Chew GWM, Teoh SCB, Agrawal R. Analysis and Outcomes of Cataract Surgery in Patients with Acquired Immunodeficiency Syndrome. Ocul Immunol Inflamm 2016; 25:535-539. [PMID: 27082491 DOI: 10.3109/09273948.2016.1158281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the surgical outcomes, complications and postoperative progression in HIV patients undergoing cataract surgery in a teaching hospital. METHODS A retrospective cohort study of patients with HIV/AIDS who had cataract surgery from January 2000 until December 2011 at a tertiary referral multidisciplinary hospital in Singapore. RESULTS We identified 44 eyes from 29 patients. Preoperatively, 41.3% had no ophthalmic manifestations of HIV/AIDS, while 16 eyes had quiescent cytomegalovirus retinitis (CMVR). Postoperatively, 1 eye developed new CMVR, while 1 eye had reactivation of previous CMVR. Of eyes with new or previous CMVR, 1 eye developed rhegmatogenous retinal detachment (RD) postoperatively. Only 3 eyes had prolonged postoperative inflammation. There were no cases of endophthalmitis or cystoid macular edema. Postoperative improvement of at least two Snellen lines was achieved in 86.6% of eyes. CONCLUSIONS Cataract surgery in HIV patients is generally safe, regardless of CD4 count, but their general and ocular health should be optimized preoperatively.
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Affiliation(s)
- Grace W M Chew
- a National Healthcare Group Eye Institute Tan Tock Seng Hospital , Singapore
| | - Stephen C B Teoh
- a National Healthcare Group Eye Institute Tan Tock Seng Hospital , Singapore.,b Eagle Eye Centre , Mt Alvernia Hospital , Singapore
| | - Rupesh Agrawal
- a National Healthcare Group Eye Institute Tan Tock Seng Hospital , Singapore
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Virgilio E, Mercantini P, Tarantino G, Montebelli F, Tallerini A, Ziparo V. Streptococcus intermedius as Causative Agent of Perianal Abscess and Metastatic Brain Abscess. Surg Infect (Larchmt) 2015; 16:209-10. [DOI: 10.1089/sur.2014.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Edoardo Virgilio
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology “Sapienza,” St. Andrea Hospital, Rome, Italy
| | - Paolo Mercantini
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology “Sapienza,” St. Andrea Hospital, Rome, Italy
| | - Giulia Tarantino
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology “Sapienza,” St. Andrea Hospital, Rome, Italy
| | - Francesco Montebelli
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology “Sapienza,” St. Andrea Hospital, Rome, Italy
| | - Anna Tallerini
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology “Sapienza,” St. Andrea Hospital, Rome, Italy
| | - Vincenzo Ziparo
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology “Sapienza,” St. Andrea Hospital, Rome, Italy
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Torremadé Barreda J, Millán Scheiding M, Suárez Fernández C, Cuadrado Campaña JM, Rodríguez Aguilera J, Franco Miranda E, Biondo S. Gangrena de Fournier: Estudio retrospectivo de 41 casos. Cir Esp 2010; 87:218-23. [DOI: 10.1016/j.ciresp.2009.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 12/24/2009] [Accepted: 12/27/2009] [Indexed: 11/30/2022]
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Morrison CA, Wyatt MM, Carrick MM. Effects of Human Immunodeficiency Virus Status on Trauma Outcomes: A Review of the National Trauma Database. Surg Infect (Larchmt) 2010; 11:41-7. [DOI: 10.1089/sur.2008.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C. Anne Morrison
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew M. Wyatt
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew M. Carrick
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Simpson MA, Keston P, Bridges A, Macleod M. Bacterial meningitis associated with a complex ischiorectal abscess. J Clin Neurosci 2009; 16:1682-3. [PMID: 19800242 DOI: 10.1016/j.jocn.2009.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 03/29/2009] [Indexed: 11/30/2022]
Abstract
We describe a case of bacterial meningitis in a 37 year old man resulting from the direct extension of an spontaneously occurring ischiorectal abscess into the intradural space. The patient presented with back pain and urinary retention and this was followed by the development of headache, photophobia and a left VIth nerve palsy. The patient was not diabetic or immunocompromised. He was treated with broad spectrum antibiotics and with drainage of the ischiorectal abscess; no organism was grown from blood, abscess contents or cerebrospinal fluid. He went on to make a full recovery.
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Affiliation(s)
- Marion A Simpson
- Department of Neurology, The Austin Hospital, 145 Studley Road, Heidelberg 3084, Victoria, Australia.
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Doepp F, Schreiber SJ, Wandinger KP, Trendelenburg G, Valdueza JM. Multiple brain abscesses following surgical treatment of a perianal abscess. Clin Neurol Neurosurg 2006; 108:187-90. [PMID: 16412840 DOI: 10.1016/j.clineuro.2004.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Revised: 11/12/2004] [Accepted: 11/26/2004] [Indexed: 11/27/2022]
Abstract
We report a case of multiple brain abscesses (BAs) in a 67-year-old man with symptoms of progredient disorientation and amnestic aphasia. Onset of symptoms occurred one week after surgical treatment of a perianal abscess. No other source of infection was identified and the abscesses were limited to the brain. The immune status was normal but a patent foramen ovale (pFO) was found. The patient was treated with high-dose antibiotics, leading to a complete radiological disappearance of the BAs. Hematogenous spread of infectious emboli from a perianal focus exclusively to the brain is very rare. In our patient, the mechanisms of infectious spread into the brain might have occurred via a cardiac right-to-left shunt or alternatively via the non-valvular vertebral venous system. In this manuscript, both pathways are critically reviewed.
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Affiliation(s)
- Florian Doepp
- Department of Neurology, University Hospital Charité, Schumannstr. 20/21, 10117 Berlin, Germany.
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Abstract
Fournier's gangrene can still be a life-threatening condition with a high mortality rate. Diagnosis and treatment should be prompt and adequate. Radiological studies may help to define the extent of the disease preoperatively in cases in which this is unclear. Surgery with extensive debridement of all necrotic tissue is the mainstay of treatment.
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Affiliation(s)
- Emilio Morpurgo
- Section of Colon and Rectal Surgery, University of Louisville, 550 South Jackson Street, Louisville, KY40292, USA
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Muñoz-villasmil J, Sands L, Hellinger M. Management of Perianal Sepsis in Immunosuppressed Patients. Am Surg 2001. [DOI: 10.1177/000313480106700522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite improvements in the supportive care of immunosuppressed patients controversy still surrounds the surgical management and outcome of anorectal sepsis in these patients. We reviewed 83 immunocompromised patients with diagnosis of perianal sepsis from 1995 to 1997. Sixty-six patients (80%) were followed for a mean of 15 months. Mean age was 44 years and 76 per cent were males. Twenty-eight per cent were HIV+, 34 per cent had inflammatory bowel disease on steroids, 20 per cent had malignancies, and 18 per cent had diabetes. Twenty-eight per cent had anal fistula, 2 per cent had perianal abscess, and 40 per cent had both. Primary sites of fistula were: transsphincteric (38%), intersphincteric (33%), superficial (20%), and suprasphincteric (3%), and multiple tracks (6%). Horseshoeing was present in 14 per cent of cases. The most commonly practiced surgical procedures were primary fistulotomy (n = 23) and fistulotomy plus drainage (n = 28). Seven patients underwent fistulotomy and ostomy and eight patients were treated with fistulectomy plus drainage. Most wounds (91%) healed within 8 weeks. Incontinence (6%) and recurrence (7%) were the most commonly observed complications. These results are similar to those seen in the general population. Perianal sepsis can be safely managed in immunocompromised patients, with high rates of healing and low complication rates. An aggressive sphincter-preserving approach in the management of these patients may be undertaken.
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Affiliation(s)
- Jose Muñoz-villasmil
- Division of Colon and Rectal Surgery, University of Miami Jackson Memorial Medical Center, Miami, Florida
| | - Laurence Sands
- Division of Colon and Rectal Surgery, University of Miami Jackson Memorial Medical Center, Miami, Florida
| | - Michael Hellinger
- Division of Colon and Rectal Surgery, University of Miami Jackson Memorial Medical Center, Miami, Florida
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Abstract
Otologic disease in patients infected with HIV occurs frequently and usually represents rhinologic disease and associated eustachian tube dysfunction rather than manifestations of HIV infection. As in all patients, the decision to operate on an HIV-infected individual who would benefit from major otologic surgery is a balance between the risks of the procedure and the possible benefits to the patient. Many concerns regarding wound infection and healing have been raised. The objective of this study is to evaluate the outcome of otologic procedures in this population. The charts of 9 men and 4 women were reviewed. Seven patients (54%) met the Centers for Disease Control and Prevention criteria for AIDS. Patients with chronic otitis media (46%) underwent tympanomastoidectomies, and the cases of acute mastoiditis (31%) were managed with simple mastoidectomies. Other procedures included repair of cerebrospinal fluid leak (15%) and stapedectomy (8%). Two patients had early complications and died during their hospitalizations. Three patients had prolonged hospital courses requiring long-term antibiotics. These 5 patients underwent urgent procedures and were severely immunocompromised. Of the remaining 8 patients only 2 had AIDS, and all had an uncomplicated postoperative course. Six of these patients were followed up for more than 1 year, and only 2 developed subsequent otologic disease.
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Affiliation(s)
- D Kohan
- Department of Otolaryngology, New York University School of Medicine
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Caird J, Abbasakoor F, Quill R. Necrotising fasciitis in a HIV positive male: an unusual indication for abdomino-perineal resection. Ir J Med Sci 1999; 168:251-3. [PMID: 10624364 DOI: 10.1007/bf02944351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We report a case of necrotising fasciitis of the genitoperineum (Fournier's gangrene) in a HIV positive male following incision and drainage of bilateral ischiorectal fossa abscesses. During surgery to debride the necrotic tissue the rectum was found to be perforated necessitating laparotomy and subsequent abdomino-perineal resection. Although previous reports of Fournier's gangrene in the HIV positive population exist, rectal involvement requiring excision has not previously been reported.
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Affiliation(s)
- J Caird
- Department of General Surgery, St. James's Hospital, Dublin
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Barrett WL, Callahan TD, Orkin BA. Perianal manifestations of human immunodeficiency virus infection: experience with 260 patients. Dis Colon Rectum 1998; 41:606-11; discussion 611-2. [PMID: 9593244 DOI: 10.1007/bf02235268] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Individuals infected with the human immunodeficiency virus often have disorders affecting the anorectum. These disorders may be complex and difficult to treat. We reported our early experience with 40 human immunodeficiency virus-positive patients with perianal disorders in 1990. We now present our series of 260 consecutive human immunodeficiency virus-positive patients with perianal disorders who underwent evaluation between 1989 and 1996 to examine the distribution of disorders, their treatments, and outcomes. METHOD Patients were identified at initial presentation and followed prospectively. RESULTS Two-hundred forty-nine (96 percent) of 260 patients were male, with an average age of 34.9 (range, 19-58) years. Average duration of human immunodeficiency virus positivity was 5 years, 5 months, with a maximum of 11 years, 5 months. Median CD4 count was 175 (range, 2-1,100) cells/mm3. Only 89 (34 percent) patients satisfied the criteria of the Centers for Disease Control and Prevention's for acquired immunodeficiency syndrome at presentation. The most frequent major presenting symptoms were anorectal pain (55 percent), a mass (19 percent), and blood in the stool (16 percent). Risk factors included homosexuality (75 percent) and a prior history of sexually transmitted disease (45 percent). Forty different perianal disorders were identified, which were categorized as benign noninfectious (18), infectious (14), neoplastic (6), and septic (2). The most common disorders were condyloma (42 percent), fistula (34 percent), fissure (32 percent), and abscess (25 percent). Neoplasms were present in 19 patients (7 percent). One hundred seventy-one patients (66 percent) had more than one disorder, with an average of 2.9 disorders among these patients. Four hundred eighty-five procedures were performed on 178 patients (2.7/patient), with no mortalities and a 2 percent complication rate. Thirty-one patients (12 percent) died during the course of follow-up, but anorectal disease was the cause of death in only two patients. CONCLUSIONS Perianal manifestations of human immunodeficiency virus infection are common, often multiple, and varied. Patients with perianal disorders seek treatment throughout the course of the human immunodeficiency virus infection, and a perianal condition may be this disease's initial manifestation. Although recurrence is common and healing delayed, improved overall management of human immunodeficiency virus infection and a healthier human immunodeficiency virus-positive patient population have improved the outcome of surgical intervention in human immunodeficiency virus-infected patients with perianal disorders.
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Affiliation(s)
- W L Barrett
- Department of Surgery, The George Washington University, Washington, DC, USA
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