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Spindler L, Etienney I, Abramowitz L, de Parades V, Pigot F, Siproudhis L, Adam J, Balzano V, Bouchard D, Bouta N, Bucau M, Carlo A, Chanal J, Charpentier C, Clifford G, Draullette M, Fathallah N, Ferré V, Fléjou JF, Fouéré S, Higuero T, Kassouri L, Kurt S, Laurain A, Leclerc E, Lepiller Q, Lesage AC, Mège D, Ménard A, Merle P, Mortreux P, Noël C, Péré H, Prétet JL, Roland D, Staumont G, Tracanelli L, Vuitton L, Wylomanski S, Zaegel-Faucher O. Screening for precancerous anal lesions linked to human papillomaviruses: French recommendations for clinical practice. Tech Coloproctol 2024; 28:23. [PMID: 38198036 PMCID: PMC10781838 DOI: 10.1007/s10151-023-02899-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024]
Abstract
In France, about 2000 new cases of anal cancer are diagnosed annually. Squamous cell carcinoma is the most common histological type, mostly occurring secondary to persistent HPV16 infection. Invasive cancer is preceded by precancerous lesions. In addition to patients with a personal history of precancerous lesions and anal cancer, three groups are at very high risk of anal cancer: (i) men who have sex with men and are living with HIV, (ii) women with a history of high-grade squamous intraepithelial lesions (HSILs) or vulvar HPV cancer, and (iii) women who received a solid organ transplant more than 10 years ago. The purpose of screening is to detect HSILs so that they can be treated, thereby reducing the risk of progression to cancer. All patients with symptoms should undergo a proctological examination including standard anoscopy. For asymptomatic patients at risk, an initial HPV16 test makes it possible to target patients at risk of HSILs likely to progress to cancer. Anal cytology is a sensitive test for HSIL detection. Its sensitivity is greater than 80% and exceeds that of proctological examination with standard anoscopy. It is indicated in the event of a positive HPV16 test. In the presence of cytological abnormalities and/or lesions and a suspicion of dysplasia on clinical examination, high-resolution anoscopy is indicated. Performance is superior to that of proctological examination with standard anoscopy. However, this technique is not widely available, which limits its use. If high-resolution anoscopy is not possible, screening by a standard proctological examination is an alternative. There is a need to develop high-resolution anoscopy and triage tests and to evaluate screening strategies.
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Affiliation(s)
- L Spindler
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - I Etienney
- Service de Proctologie, Hôpital Diaconesses-Croix Saint Simon, Paris, France
| | - L Abramowitz
- Service de Proctologie, APHP Hôpital Bichat-Claude Bernard and Ramsay GDS Clinique Blomet, Paris, France
| | - V de Parades
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - F Pigot
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - L Siproudhis
- Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes, France
| | - J Adam
- Service d'Anatomopathologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V Balzano
- Service de Gastroentérologie et Oncologie Digestive, CHU Tours, Tours, France
| | - D Bouchard
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - N Bouta
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - M Bucau
- Service d'Anatomopathologie, AP-HP Hôpital Bichat-Claude Bernard, Paris, France
| | - A Carlo
- Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes, France
| | - J Chanal
- Service de Dermatologie, AP-HP, Hôpital Tarnier, Paris, France
| | - C Charpentier
- Département de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, INSERM, IAME, Université de Paris, Paris, France
| | - G Clifford
- Early Detection, Prevention, and Infections Branch, International Agency for Research On Cancer, Lyon, France
| | - M Draullette
- Service d'Hépato-Gastroentérologie et Assistance Nutritive, AP-HP, Hôpital Beaujon, Clichy, France
| | - N Fathallah
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V Ferré
- Département de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, INSERM, IAME, Université de Paris, Paris, France
| | - J-F Fléjou
- Service d'Anatomopathologie, Cerbapath, Paris, France
| | - S Fouéré
- Service de Dermatologie, AP-HP, Hôpital Saint-Louis, Université de Paris, Paris, France
- Centre des Maladies Sexuellement Transmises, AP-HP, Hôpital Saint-Louis, Paris, France
| | - T Higuero
- Gastro-entérologue, proctologue medico-chirurgical, Beausoleil, France
| | - L Kassouri
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - S Kurt
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Laurain
- Service de Proctologie, APHP Hôpital Bichat-Claude Bernard and Ramsay GDS Clinique Blomet, Paris, France
| | - E Leclerc
- Service d'Hépato-Gastroentérologie, CHU Clermont-Ferrand, Inserm, 3iHP, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Q Lepiller
- Laboratoire de Virologie, CHU de Besançon, Besançon, France
| | - A-C Lesage
- Service de Proctologie, Hôpital Diaconesses-Croix Saint Simon, Paris, France
| | - D Mège
- Service de Chirurgie Digestive, Université d'Aix Marseille, AP-HM, Hôpital de la Timone, Marseille, France
| | - A Ménard
- Institut Hospitalo-Universitaire Méditerranée Infection, AP-HM, Hôpital Nord, Université d'Aix Marseille, Marseille, France
| | - P Merle
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - P Mortreux
- Service de Gastroentérologie, Centre Hospitalier de Bethune Beuvry, Beuvry, France
| | - C Noël
- Service d'Hépato-Gastroentérologie, CHU de Brest, Brest, France
| | - H Péré
- Laboratoire de Virologie, Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Functional Genomics of Solid Tumors (FunGeST), Centre de Recherche des Cordelier, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - J-L Prétet
- EA3181, Université de Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, Besançon, France
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France
| | - D Roland
- Service de Proctologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - G Staumont
- Service d'Hépato-Gastroentérologie et de Proctologie, Clinique La Croix du Sud, Quint-Fonsegrives, France
| | - L Tracanelli
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - L Vuitton
- Service de Gastroentérologie, CHU de Besançon, Université de Bourgogne Franche-Comté, Besançon, France
| | - S Wylomanski
- Service de Gynécologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - O Zaegel-Faucher
- Service d'Immuno-Hématologie Clinique, AP-HM, CHU Sainte-Marguerite, Marseille, France
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Laurain A, Bouchard D, Rouillon JM, Petit P, Liddo A, Vinson Bonnet B, Venara A, Didelot JM, Bonnaud G, Senéjoux A, Higuero T, Delasalle P, Tarrerias AL, Devulder F, Castinel A, Thomas C, Pillant Le Moult H, Favreau-Weltzer C, Abramowitz L. French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease. Tech Coloproctol 2023; 27:873-883. [PMID: 37005961 PMCID: PMC10485119 DOI: 10.1007/s10151-023-02787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/14/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of haemorrhoidal disease with 1 year's follow-up. METHOD This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II-III haemorrhoids. RFA was performed in the operating room under locoregional or general anaesthesia. Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery. Secondary endpoints were evolution of symptoms (prolapsus, bleeding, pain, itching, anal discomfort), complications, postoperative pain and medical leave. RESULTS A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres. Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months. At 3 months, the rate of patients reporting bleeding (21% vs. 84%, p < 0.001), prolapse (34% vs. 91.3%, p < 0.001) and anal discomfort (0/10 vs. 5/10, p < 0.0001) decreased significantly. Median medical leave was 4 days [1-14]. Postoperative pain was 4/10, 1/10, 0/10 and 0/10 at weeks 1, 2, 3 and 4. Seven patients (5.4%) were reoperated on by haemorrhoidectomy for relapse, and three for complications. Reported complications were haemorrhage (3), dysuria (3), abscess (2), anal fissure (1), external haemorrhoidal thrombosis (10), pain requiring morphine (11). Degree of satisfaction was high (+ 5 at 3 months on a - 5/+ 5 scale). CONCLUSION RFA is associated with an improvement in quality of life and symptoms with a good safety profile. As expected for minimally invasive surgery, postoperative pain is minor with short medical leave. CLINICAL TRIAL REGISTRATION AND DATE Clinical trial NCT04229784 (18/01/2020).
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Affiliation(s)
- A Laurain
- Clinique Blomet Ramsay santé, 136 rue Blomet, 75015, Paris, France.
- Service de Proctologie, Hôpital Bichat, APHP, 46 Rue Henri Huchard, 75018, Paris, France.
| | - D Bouchard
- Service de Proctologie, Hôpital Bagatelle, 33400, Talence, France
| | - J-M Rouillon
- Service de Gastroentérologie, Polyclinique Montréal, Route de Bram, 11000, Carcassonne, France
| | - P Petit
- Clinique Santé Atlantique, Elsan, 44800, Saint Herblain, France
| | - A Liddo
- Cabinet médical, 1 Quai du Havre, 59200, Tourcoing, France
- Clinique de la Victoire, 1 Quai du Havre, 59200, Tourcoing, France
| | - B Vinson Bonnet
- Service de Chirurgie Digestive CHI Poissy, St Germain, France
| | - A Venara
- Service de Chirurgie Viscérale et Endocrinienne CHU Angers, 4 rue Larrey, Angers, France
| | - J-M Didelot
- Cabinet médical, 1019 Avenue du Pr Louis Ravaz, 34080, Montpellier, France
- Clinique Clémentville, 25 Rue de Clémentville, 34070, Montpellier, France
| | - G Bonnaud
- Clinique Ambroise Paré, 31000, Toulouse, France
| | - A Senéjoux
- Centre Hospitalier Privé, 6 Bd de la Boutière, 35760, Saint Grégoire, France
| | - T Higuero
- Cabinet médical, 11, bd du général Leclerc, 06240, Beausoleil, France
- Clinique Kantys centre, 7 avenue Durante, 06004, Nice, France
| | - P Delasalle
- Clinique du Palais, 25 Avenue Chiris, 06130, Grasse, France
| | | | - F Devulder
- SELARL Hépato-gastroentérologie, 89 rue Louis Victor de Broglie, 51430, Bezannes, France
| | - A Castinel
- Service de Proctologie, Clinique Tivoli Ducos, 91 rue de Rivière, Bordeaux, France
| | - C Thomas
- Service d'Hépato-gastroentérologie, Institut mutualiste Montsouris, 40 boulevard Jourdan, 75014, Paris, France
- Service de Proctologie, Hôpital St Joseph rue Losserand, 75014, Paris, France
| | - H Pillant Le Moult
- Clinique Blomet Ramsay santé, 136 rue Blomet, 75015, Paris, France
- Service de Proctologie, Hôpital St Joseph rue Losserand, 75014, Paris, France
| | | | - L Abramowitz
- Clinique Blomet Ramsay santé, 136 rue Blomet, 75015, Paris, France
- Service de Proctologie, Hôpital Bichat, APHP, 46 Rue Henri Huchard, 75018, Paris, France
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Bouchard D, Pigot F, de Parades V, Staumont G, Abramowitz L, Siproudhis L, Bouchard D, Pigot F, de Parades V, Staumont G, Abramowitz L, Siproudhis L, Tracanelli L, Fathallah N, Babin-Pigot E, Ferry M, Bouguen G, Laharie D, Cotte E, Panis Y, Peyrin-Biroulet L, Roblin X, Zerbib P. Management of perianal fistulas in Crohn’s disease: a 2021 update of the French National Society of Coloproctology consensus. Tech Coloproctol 2022; 26:805-811. [DOI: 10.1007/s10151-022-02678-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
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Venara A, Brochard C, Fritel X, Bridoux V, Abramowitz L, Legendre G, Siproudhis L. Management of obstetrical injuries to the anal sphincter: A survey of French current practice and perceptions according to the specialties. J Visc Surg 2021; 158:378-384. [PMID: 33446467 DOI: 10.1016/j.jviscsurg.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM OF THE STUDY To conduct a survey of current practice in the management of obstetrical anal sphincter injuries (OASI) and to compare short, medium and long-term practices according to the specialty of the surgeon. PATIENTS AND METHODS A 50-item questionnaire was addressed by mail to various specialists via the national learned societies. The questionnaire was addressed only to practitioners who currently managed OASI in their practice. RESULTS Of the 135 healthcare professionals who responded, 57 were sub-specialists in ano-rectal surgery (42.2%) and 78 were obstetrical or gynecological specialists (OB-GYN) (57.8%). Management in the acute period after OASI was similar among the specialties and 50% of the practitioners did not perform suture repair of the internal sphincter. Furthermore, few gynecological specialists recommended systematic consultation with an ano-rectal specialist during acute management. In the medium term, ano-rectal specialists were more likely to explore gastro-intestinal symptoms, either clinically or through para-clinical studies. However, these studies did not systematically lead to interventional management in the absence of consensus, particularly for medium-term sphincter repair. In addition, 25% of practitioners recommended that patients undergo systematic delivery by caesarean section for further pregnancies after OASI. In the long term (>12 months), there were substantial differences in management of OASI not only between specialties but also within the same specialty. CONCLUSION The various specialists should coordinate to propose multidisciplinary recommendations on the management of OASI.
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Affiliation(s)
- A Venara
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France; Société nationale française de coloproctologie (SNFCP), France; Groupe de recherche en proctologie (GREP), France; Association française de chirurgie (AFC), France; Faculté de santé, département de médecine, université Angers, 49045 Angers cedex 01, France; Laboratoire IHFIH, UPRES EA 3859, France.
| | - C Brochard
- Société nationale française de coloproctologie (SNFCP), France; Groupe de recherche en proctologie (GREP), France; Service des maladies de l'appareil digestif, unité de proctologie, CHU Rennes Pontchaillou, 35000 Rennes, France
| | - X Fritel
- Collège national des obstétriciens et gynécologues français (CNGOF), France; Université de Poitiers-CHU de Poitiers, service de gynécologie-obstétrique et médecine de la reproduction, 86021 Poitiers, France
| | - V Bridoux
- Association française de chirurgie (AFC), France; Service de chirurgie viscérale et endocrinienne, CHU de Rouen, 76000 Rouen, France
| | - L Abramowitz
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France; Société nationale française de coloproctologie (SNFCP), France; Service d'hépato-gastroentérologie et proctologie, hôpital Bichat-Claude Bernard, 75018 Paris, France; Ramsay général de santé, clinique Blomet, 75015 Paris, France
| | - G Legendre
- Collège national des obstétriciens et gynécologues français (CNGOF), France; Service de gynécologie obstétrique, CHU d'Angers, 49933 Angers cedex 9, France
| | - L Siproudhis
- Société nationale française de coloproctologie (SNFCP), France; Groupe de recherche en proctologie (GREP), France; Laboratoire IHFIH, UPRES EA 3859, France
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5
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Boudiaf R, Bouchard D, Rivière P, Brochard C, Laharie D, Abramowitz L, Pigot F. Assessment of sexual dysfunction in patients with perianal Crohn's disease. Colorectal Dis 2021; 23:114-122. [PMID: 32961618 DOI: 10.1111/codi.15375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 08/02/2020] [Accepted: 08/22/2020] [Indexed: 12/14/2022]
Abstract
AIM Over the past 10 years, several studies have focused on sexuality in patients with Crohn's disease. Very few of them specifically focused on perianal disease (PD). This study aimed to compare the prevalence of sexual dysfunction (SD) in Crohn's disease patients with active PD versus controls without active PD. METHOD Patients from 14 French centres with active PD, defined by the presence of symptomatic ulceration, fistula or stenosis, were arbitrarily included. They were compared with controls from the existing SEXIA cohort. Men completed the International Index of Erectile Function (IIEF) and women the Female Sexual Function Index (FSFI). The primary end-point was SD defined by FSFI < 26.55 in women and IIEF < 42.9 in men. RESULTS Ninety-seven patients (64 women, 33 men) and 238 controls (131 women, 107 men) were included. SD was found in 66% of the female patients versus 50% of the controls (P = 0.04). In the male population, SD was found in 30% of the cases versus 16% of the controls (P = 0.06). Erectile dysfunction affected 46% of the male patients and 43% of the controls (P = 0.8). On multivariate analysis, the predictive factor most strongly associated with SD in women was severely active anal PD defined by a perineal disease activity index > 4 [OR = 13.05 (2.32-73.44)]. CONCLUSION Women with active PD had an increased prevalence of SD compared with controls without active PD. In the male population, the study was unable to determine whether there was a difference as it was underpowered.
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Affiliation(s)
- R Boudiaf
- Department of Gastroenterology, CHU de Bordeaux, Pessac, France.,Department of Proctology, Maison de Santé Bagatelle, Talence, France
| | - D Bouchard
- Department of Proctology, Maison de Santé Bagatelle, Talence, France
| | - P Rivière
- Department of Gastroenterology, CHU de Bordeaux, Pessac, France
| | - C Brochard
- Department of Gastroenterology, CHU de Rennes, Rennes, France
| | - D Laharie
- Department of Gastroenterology, CHU de Bordeaux, Pessac, France
| | - L Abramowitz
- Ramsay Santé, Clinique Blomet, Paris, France.,Department of Proctology, Hôpital Bichat, Paris, France
| | - F Pigot
- Department of Proctology, Maison de Santé Bagatelle, Talence, France
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- Department of Proctology, Hôpital Bichat, Paris, France
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Abramowitz L, Mandelbrot L, Bourgeois Moine A, Tohic AL, Carne Carnavalet C, Poujade O, Roy C, Tubach F. Caesarean section in the second delivery to prevent anal incontinence after asymptomatic obstetric anal sphincter injury: the EPIC multicentre randomised trial. BJOG 2020; 128:685-693. [PMID: 32770616 DOI: 10.1111/1471-0528.16452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether planned caesarean section (CS) for a second delivery protects against anal incontinence in women with obstetric anal sphincter lesions. DESIGN Randomised trial. SETTING Six maternity units in the Paris area. SAMPLE Women at high risk of sphincter lesions (first delivery with third-degree laceration and/or forceps) but no symptomatic anal incontinence. METHODS Endoanal ultrasound was performed in the third trimester of the second pregnancy. Women with sphincter lesions were randomised to planned CS or vaginal delivery (VD). MAIN OUTCOME MEASURES Anal incontinence at 6 months postpartum. Secondary outcomes were urinary incontinence, sexual morbidity, maternal and neonatal morbidities and worsening of external sphincter lesions. RESULTS Anal sphincter lesions were detected by ultrasound in 264/434 women enrolled (60.8%); 112 were randomised to planned VD and 110 to planned CS. At 6-8 weeks after delivery, there was no significant difference in anal continence between the two groups. At 6 months after delivery, median Vaizey scores of anal incontinence were 1 (interquartile range 0-4) in the CS group and 1 (interquartile range 0-3) in the VD group (P = 0.34). There were no significant differences for urinary continence, sexual functions or for other maternal and neonatal morbidities. CONCLUSIONS In women with asymptomatic obstetric anal sphincter lesions diagnosed by ultrasound, planning a CS had no significant impact on anal continence 6 months after the second delivery. These results do not support advising systematic CS for this indication. TWEETABLE ABSTRACT Caesarean section for the second delivery did not protect against anal incontinence in women with asymptomatic obstetric anal sphincter lesions.
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Affiliation(s)
- L Abramowitz
- Hôpital Bichat, Proctology Unit, Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Ramsay général de santé, clinique Blomet, Paris, France
| | - L Mandelbrot
- Department of Obstetrics and Gynaecology, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.,Université de Paris, Paris, France.,Inserm IAME U1137, Paris, France
| | - A Bourgeois Moine
- Department of Obstetrics and Gynaecology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A L Tohic
- Department of Obstetrics and Gynaecology, Centre Hospitalier de Versailles, Le Chesnay, France
| | - C Carne Carnavalet
- Department of Obstetrics and Gynaecology, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - O Poujade
- Department of Obstetrics and Gynaecology Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Clichy, France.,Department of Obstetrics and Gynaecology, Hôpital des Rives de Seine, Neuilly, France
| | - C Roy
- Unité de Recherche Clinique, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM CIC-EC 1425, Paris, France
| | - F Tubach
- Département de Santé Publique, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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Descamps V, Lariven S, Koskas M, Dieude P, Abramowitz L, Deschamps L, Charpentier C, Brunet-Possenti F. Intérêt potentiel des anti-IL17 dans la prise en charge du psoriasis en cas de pathologie tumorale associée aux HPV à haut risque oncogène (HPVHR). Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Geffrier C, de Parades V, Abramowitz L, Benfredj P, Bonnaud G, Bord C, Bouchard D, Bouguen G, Devulder F, Didelot JM, Fathallah N, Higuero T, Lesage X, Nouts A, Petit P, Pigot F, Pommaret E, Roumeguere P, Siproudhis L, Staumont G, Zeitoun JD, Marteau P. Online training on how to diagnose anoperineal lesions of Crohn's disease: Do pictures matter? A nationwide randomized study. Clin Res Hepatol Gastroenterol 2019; 43:483-496. [PMID: 30935906 DOI: 10.1016/j.clinre.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/03/2018] [Indexed: 02/04/2023]
Abstract
UNLABELLED Any gastroenterologist must be trained to properly diagnose anoperineal lesions in patients with Crohn's disease (APLOC). The aim of this study was to establish whether adding pictures would improve teaching effectiveness of the diagnosis of APLOC to French gastroenterology trainees. METHOD Trainees were asked to answer a first web-based survey consisting of evaluating 12 pictures of APLOC with a closed answer questionnaire. They were then randomized in 2 groups. Group A received an online teaching with typical pictures and APLOC definitions and group B definitions only. Trainees were asked again seven days later to answer a second survey with 12 other pictures of APLOC and 14 experts also answered this survey. Diagnostic scores were expressed in %. The primary endpoint was the comparison of the score of survey 2 between the two groups of trainees. Secondary endpoints were to compare results of survey 2 between trainees of both groups and experts, and assess diagnosis of each lesion. RESULTS Two hundred fourty eight trainees among 465 answered survey 1, and 195 survey 2. The diagnostic score was 71.9% for groups A and B and 74.6% for experts (differences NS). After training diagnosis of ulceration was 72% for group A and 72.9% for group B, fistulae 85.2% versus 85.8%, erythema 44.1% vs. 55.6%, anoperineal scars 67.5% vs. 65.6%, and abscess 100% (differences NS). CONCLUSION There was no difference between the two teaching methods. Further research should be performed aiming at improving teaching material and quotation baremes.
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Affiliation(s)
- C Geffrier
- Department of digestive diseases, CHU de Louis-Mourier, AP-HP, 92700 Colombes, France
| | - V de Parades
- Department of proctology, groupe hospitalier Paris Saint Joseph, institut Léopold-Bellan, Paris, France
| | - L Abramowitz
- Department of proctology and digestive diseases, CHU de Bichat, AP-HP, Paris, France
| | - P Benfredj
- Department of proctology, groupe hospitalier Paris Saint Joseph, institut Léopold-Bellan, Paris, France
| | - G Bonnaud
- Department of digestive diseases, clinique des Cèdres, 31700 Cornebarrieu, France
| | - C Bord
- Department of proctology, clinique Beau Soleil, 34070 Montpellier, France
| | - D Bouchard
- Department of proctology, hôpital Bagatelle, 33401 Talence, France
| | - G Bouguen
- Department of digestive diseases, CHU de Pontchaillou, Rennes, France
| | - F Devulder
- Department of digestive diseases and proctology, polyclinique de Courlancy, 51100 Reims, France
| | - J M Didelot
- Department of proctology, Clinique Clementville, 34070 Montpellier, France
| | - N Fathallah
- Department of proctology, Clinique St Antoine, 06004 Nice, France
| | - T Higuero
- Department of proctology, 59280 Armentieres, France
| | - X Lesage
- Department of proctology, 94120 Fontenay-sous-Bois, France
| | - A Nouts
- Department of proctology, clinique Saint Augustin, 44000 Nantes, France
| | - P Petit
- Department of proctology, clinique Tivoli, 33000 Bordeaux, France
| | - F Pigot
- Department of proctology, clinique St Jean-Languedoc, 31400 Toulouse, France
| | - E Pommaret
- Department of proctology, groupe hospitalier Paris Saint Joseph, institut Léopold-Bellan, Paris, France
| | - P Roumeguere
- Department of proctology, clinique Tivoli, 33000 Bordeaux, France
| | - L Siproudhis
- Department of digestive diseases, CHU de Pontchaillou, Rennes, France
| | - G Staumont
- Department of proctology, clinique St Jean-Languedoc, 31400 Toulouse, France
| | - J D Zeitoun
- Department of digestive diseases and proctology, CHU de Saint Antoine, AP-HP, 75012 Paris, France
| | - P Marteau
- Philippe-Marteau, université Paris Sorbonne, AP-HP, pole digestif, hôpital Saint Antoine 75012 Paris, France.
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9
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Bouchard D, Brochard C, Vinson-Bonnet B, Staumont G, Abramowitz L, Benfredj P, Fathallah N, Faucheron JL, Higuero T, Panis Y, de Parades V, Siproudhis L, Laharie D, Pigot F. How to manage anal ulcerations and anorectal stenosis in Crohn's disease: algorithm-based decision making : French National Working Group Consensus 2018. Tech Coloproctol 2019; 23:353-360. [PMID: 30937646 DOI: 10.1007/s10151-019-01971-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/14/2019] [Indexed: 12/24/2022]
Abstract
The French National Society of Coloproctology established national recommendations for the treatment of anoperineal lesions associated with Crohn's disease. Treatment strategies for anal ulcerations and anorectal stenosis are suggested. Recommendations have been graded following international recommendations, and when absent professional agreement was established. For each situation, practical algorithms have been drawn.
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Affiliation(s)
- D Bouchard
- Bagatelle Hospital, 203 route de Toulouse, 33401, Talence Cedex, France.
| | - C Brochard
- University Hospital Center, Rennes Cedex 9, France
| | | | - G Staumont
- La Croix du Sud Clinic, Quint-Fonsegrives, France
| | - L Abramowitz
- Ramsay Générale de Santé, Blomet Clinic, Paris, France
| | | | | | - J-L Faucheron
- University Hospital Center Grenoble-Alpes, La Tronche, France
| | | | - Y Panis
- Beaujon Hospital, Clichy, France
| | | | - L Siproudhis
- University Hospital Center, Rennes Cedex 9, France
| | - D Laharie
- Umniversity Hospital Center Haut Lévêque, Pessac Cedex, France
| | - F Pigot
- Bagatelle Hospital, 203 route de Toulouse, 33401, Talence Cedex, France
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10
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Bouchard D, Pigot F, Staumont G, Siproudhis L, Abramowitz L, Benfredj P, Brochard C, Fathallah N, Faucheron JL, Higuero T, Panis Y, de Parades V, Vinson-Bonnet B, Laharie D. Management of anoperineal lesions in Crohn's disease: a French National Society of Coloproctology national consensus. Tech Coloproctol 2019; 22:905-917. [PMID: 30604249 DOI: 10.1007/s10151-018-1906-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/07/2018] [Indexed: 12/11/2022]
Abstract
The French National Society of Coloproctology established national recommendations for the treatment of anoperineal lesions associated with Crohn's disease. Treatment strategies for acute abscesses, active fistulas (active denovo and still active under treatment), fistulas in remission, and rectovaginal fistulas are suggested. Recommendations have been graded following the international recommendations, and when absent, professional agreement has been established. For each situation, practical algorithms have been drawn.
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Affiliation(s)
- D Bouchard
- Hôpital Bagatelle, 203 Route de Toulouse, 33401, Talence Cedex, France.
| | - F Pigot
- Hôpital Bagatelle, 203 Route de Toulouse, 33401, Talence Cedex, France
| | - G Staumont
- Clinique Saint Jean du Languedoc, 20 Route de Revel, 31400, Toulouse, France
| | - L Siproudhis
- Centre Hospitalier Universitaire, 35033, Rennes Cedex 9, France
| | - L Abramowitz
- Centre Hospitalier Universitaire Bichat, 75877, Paris, France
| | - P Benfredj
- Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - C Brochard
- Centre Hospitalier Universitaire, 35033, Rennes Cedex 9, France
| | - N Fathallah
- Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - J-L Faucheron
- Centre Hospitalier Universitaire Grenoble-Alpes, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - T Higuero
- , 11 Boulevard du Général Leclerc, 06240, Beausoleil, France
| | - Y Panis
- Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - V de Parades
- Hôpital Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - B Vinson-Bonnet
- Hôpital de Poissy-Saint Germain en Laye, 10 Rue Champ Gaillard, 78300, Poissy, France
| | - D Laharie
- Centre Hospitalier Universitaire Haut Lévêque, Avenue Magellan, 33604, Pessac Cedex, France
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11
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Abramowitz L, Bouchard D, Siproudhis L, Trompette M, Pillant H, Bord C, Senejoux CA, Favreau‐Weltzer C, Berdeaux G, Zkik A. Psychometric properties of a questionnaire (HEMO-FISS-QoL) to evaluate the burden associated with haemorrhoidal disease and anal fissures. Colorectal Dis 2019; 21:48-58. [PMID: 30171745 PMCID: PMC7379620 DOI: 10.1111/codi.14393] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022]
Abstract
AIM Current questionnaires designed to evaluate the burden of haemorrhoidal disease ignore symptoms such as bleeding, pain and itching. A specific questionnaire is needed to evaluate the global impact of anal disorders on patients' daily lives. METHOD We developed a questionnaire (HEMO-FISS-QoL) to assess the symptom burden of anal disorders and administered it to 256 patients (mean age 46.2 years; men 60.4%) with haemorrhoidal disease (67.2%), anal fissure (29.3%) or both (3.5%). Psychometric properties were evaluated by testing the acceptability, construct validity and reliability of the questionnaire. Principal components and multi-trait analyses were used to identify dimensions and to assess construct validity. Backward Cronbach alpha curves and a graded response model were used to reduce the number of items and modalities. External validity was evaluated against SF-12 and the Psychological Global Well-Being Index (PGWBI) using Spearman's correlation coefficient. RESULTS Principal component analysis defined four dimensions: physical disorders, psychology, defaecation and sexuality. The number of questions was reduced from 38 to 23. The HEMO-FISS-QoL scores correlated well with those of the SF-12 and PGWBI (P < 0.001). Cronbach's coefficients (all > 0.7) reflected good internal reliability of the different dimensions. The total score increased with the severity of the anal disorders and with their consequences (days off work and personal spending related to the disease). CONCLUSION The HEMO-FISS-QoL questionnaire reliably evaluates the global impact of haemorrhoids and anal fissures on patients' daily lives. This simple tool may prove useful for treatment evaluation in clinical trials and daily practice.
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Affiliation(s)
- L. Abramowitz
- AP‐HPProctologie Médico Chirurgicale du Service de GastroentérologieCHU BichatParisFrance,Clinique BlometRamsay GDSGREP (Groupe de Recherche en Proctologie de la SNFCP)ParisFrance
| | - D. Bouchard
- Service de ProctologieHôpital BagatelleTalenceFrance
| | - L. Siproudhis
- Service de Gastroentérologie et Groupe Imphy CIC1414CHUPontchaillouRennesFrance
| | - M. Trompette
- AP‐HPProctologie Médico Chirurgicale du Service de GastroentérologieCHU BichatParisFrance,Clinique BlometRamsay GDSGREP (Groupe de Recherche en Proctologie de la SNFCP)ParisFrance
| | - H. Pillant
- Service de ProctologieGroupe Hospitalier Saint JosephParisFrance
| | - C. Bord
- Polyclinique de Saint RochMontpellierFrance
| | | | | | | | - A. Zkik
- Pierre Fabre SABoulogne‐BillancourtFrance
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12
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Nassereddine H, Charpentier C, Bucau M, Joly V, Bienvenu L, Davitian C, Abramowitz L, Benabderrahmane D, Kotelevets L, Chastre E, Lehy T, Walker F. Interest of cytology combined with Xpert ® HPV and Anyplex ® II HPV28 Detection human papillomavirus (HPV) typing: differential profiles of anal and cervical HPV lesions in HIV-infected patients on antiretroviral therapy. HIV Med 2018; 19:698-707. [PMID: 30062761 DOI: 10.1111/hiv.12661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to assess the interest to combine cytological examination and human papillomavirus (HPV) typing of anal and cervical Papanicolaou (Pap) smears of HIV-infected patients on combination antiretroviral therapy (cART), to evaluate whether differences in prevalence exist between anal and cervical squamous intraepithelial lesions in patients with high-risk oncogenic HPV infection. METHODS Anal and/or cervical Pap smears were obtained by anoscopy and/or colposcopy in 238 subjects recruited consecutively in 2015: anal smears were obtained from 48 male and female patients [42 men; 35 men who have sex with men (MSM)] and cervical smears from 190 female patients. Cytological Bethesda classification was coupled with HPV typing. HPV typing was performed, on the same smears, using the Xpert® HPV Assay, which detects only high-risk HPV (hrHPV), and the Anyplex® II HPV28 Detection assay, which detects hrHPV and low-risk (lr) HPV. RESULTS Our data showed clear-cut differences between the anal and cervical samples. Compared with the cervical samples, the anal samples exhibited (1) more numerous cytological lesions, which were histologically proven; (2) a higher hrHPV infection prevalence; (3) a higher prevalence of multiple hrHPV coinfections whatever HPV typing kit was used; (4) a predominance of HPV16 and HPV18/45 types. Overall, there was an almost perfect agreement between the two HPV typing assays (absolute agreement = 90.3%). CONCLUSIONS Co-testing consisting of cytology and HPV typing is a useful screening tool in the HIV-infected population on cART. It allows detection of prevalence differences between anal and cervical HPV-related lesions. As recently recommended, anal examination should be regularly performed especially in HIV-infected MSM but also in HIV-infected women with genital hrHPV lesions.
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Affiliation(s)
- H Nassereddine
- Pathology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - C Charpentier
- IAME, UMR 1137, INSERM, Sorbonne Paris Cité, AP-HP, Virology Laboratory, Bichat-Claude Bernard Hospital, AP-HP, Université Paris Diderot, Paris, France
| | - M Bucau
- Pathology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - V Joly
- IAME, UMR 1137, INSERM, Sorbonne Paris Cité, AP-HP, Infectious diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Université Paris Diderot, Paris, France
| | - L Bienvenu
- Pathology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - C Davitian
- Gynecology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - L Abramowitz
- Proctology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - D Benabderrahmane
- Proctology Department, Bichat-Claude Bernard Hospital, Paris, France
| | - L Kotelevets
- INSERM U1149, Faculté de Médecine, Centre de recherche sur l'inflammation, Paris, France
| | - E Chastre
- INSERM U1149, Faculté de Médecine, Centre de recherche sur l'inflammation, Paris, France
| | - T Lehy
- Pathology Department, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U1149, Faculté de Médecine, Centre de recherche sur l'inflammation, Paris, France
| | - F Walker
- Pathology Department, Bichat-Claude Bernard Hospital, Paris, France.,Proctology Department, Bichat-Claude Bernard Hospital, Paris, France
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13
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Abramowitz L, Benabderrahmane D, Walker F, Yazdapanah Y, Yéni P, Rioux C, Bouscarat F, Lafferre E, Mentré F, Duval X. Determinants of macroscopic anal cancer and precancerous lesions in 1206 HIV-infected screened patients. Colorectal Dis 2016; 18:997-1004. [PMID: 26896041 DOI: 10.1111/codi.13304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/10/2015] [Indexed: 02/08/2023]
Abstract
AIM Anal screening is recommended in HIV-positive patients, especially men who have sex with men (MSM), due to an increased incidence of anal cancer. The optimal screening methods are not generally agreed. METHOD Screening for anal lesions by anorectal examination, including anoscopy, was offered to HIV-positive outpatients in a tertiary care university hospital regardless of gender or sexual orientation. RESULTS Among the 1206 screened patients (701 MSM, 247 heterosexual men, 258 women), 311 (26%) had histologically proven lesions related to human papilloma virus (HPV) (34% MSM, 14% heterosexual men, 14% women); 123 (10%) had low-grade dysplasia and 70 (6%) high-grade dysplasia. Seven anal cancers were also diagnosed. Determinants of any lesion were age < 45 years [OR = 1.56 (95% CI, 1.16-2.11)], a CD4 count of < 200/mm3 [OR = 2.54 (1.71-3.78)], receptive anal intercourse [OR =3.03 (2.06-4.47)], sub-Saharan African origin [OR = 0.53 (0.33-0.85)], and history of HPV-related lesion [OR = 1.84 (1.35-2.51)]. These determinants were similar for all different grades of dysplasia. In patient subgroup analysis, receptive anal intercourse, the CD4 cell count and a history of HPV lesions were determinants of HPV-positivity in all patients, whereas age was only a determinant in men. CONCLUSION Anoscopy is an alternative method for anal screening in an HIV-positive population. This screening has to be compared with other tools in populations at high risk of anal cancer.
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Affiliation(s)
- L Abramowitz
- AP-HP, Department of Gastroenterology and Proctology, Bichat University Hospital, Paris, France.
| | - D Benabderrahmane
- AP-HP, Department of Gastroenterology and Proctology, Bichat University Hospital, Paris, France
| | - F Walker
- Department of Anatomopathology, Bichat University Hospital, Paris, France
| | - Y Yazdapanah
- Department of Infectious and Tropical Diseases, Bichat University Hospital, Paris, France.,Paris 7 Denis Diderot University, Paris, France
| | - P Yéni
- Department of Infectious and Tropical Diseases, Bichat University Hospital, Paris, France.,Paris 7 Denis Diderot University, Paris, France
| | - C Rioux
- Department of Infectious and Tropical Diseases, Bichat University Hospital, Paris, France.,Paris 7 Denis Diderot University, Paris, France
| | - F Bouscarat
- AP-HP, Department of Dermatology, Bichat University Hospital, Paris, France
| | - E Lafferre
- AP-HP, Department of Gastroenterology and Proctology, Bichat University Hospital, Paris, France
| | - F Mentré
- Paris 7 Denis Diderot University, Paris, France.,Department of Biostatistics, Bichat University Hospital, Paris, France
| | - X Duval
- Inserm, CIC 1425, Clinical Investigation Center, Bichat University Hospital, Paris, France. .,Inserm, IAME UMR 1138, Bichat University Hospital, Paris, France.
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14
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Higuero T, Abramowitz L, Castinel A, Fathallah N, Hemery P, Laclotte Duhoux C, Pigot F, Pillant-Le Moult H, Senéjoux A, Siproudhis L, Staumont G, Suduca JM, Vinson-Bonnet B. Guidelines for the treatment of hemorrhoids (short report). J Visc Surg 2016; 153:213-8. [PMID: 27209079 DOI: 10.1016/j.jviscsurg.2016.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hemorrhoids are a common medical problem that is often considered as benign. The French Society of Colo-Proctology (Société nationale française de colo-proctologie [SNFCP]) recently revised its recommendations for the management of hemorrhoids (last issued in 2001), based on the literature and consensual expert opinion. We present a short report of these recommendations. Briefly, medical treatment, including dietary fiber, should always be proposed in first intention and instrumental treatment only if medical treatment fails, except in grade ≥III prolapse. Surgery should be the last resort, and the patient well informed of the surgical alternatives, including the possibility of elective ambulatory surgery, if appropriate. Postoperative pain should be prevented by the systematic implementation of a pudendal block and multimodal use of analgesics.
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Affiliation(s)
- T Higuero
- 11, boulevard du général Leclerc, 06240 Beausoleil, France.
| | - L Abramowitz
- Unité de proctologie médico-chirurgicale, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France; 95, rue de Passy, 75016 Paris, France
| | - A Castinel
- 43, bis rue de Strasbourg, 33000 Bordeaux, France
| | - N Fathallah
- Institut de proctologie Léopold-Bellan, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - P Hemery
- 5, rue Marceau, 44000 Nantes, France
| | | | - F Pigot
- Hôpital Bagatelle, 203, route de Toulouse, BP 50048, 33401 Talence cedex, France
| | - H Pillant-Le Moult
- Institut de proctologie Léopold-Bellan, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - A Senéjoux
- CHP Rennes Saint-Grégoire, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - L Siproudhis
- Service de gastroentérologie, CHU Pontchaillou, 35033 Rennes cedex 9, France
| | - G Staumont
- Clinique St.-Jean Languedoc, 20, route de Revel, Cs 37707, 31077 Toulouse cedex 4, France
| | - J M Suduca
- Clinique St.-Jean Languedoc, 20, route de Revel, Cs 37707, 31077 Toulouse cedex 4, France
| | - B Vinson-Bonnet
- Service de chirurgie digestive, centre hospitalier inter-communal de Poissy Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, BP 73082, 78303 Poissy cedex, France
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15
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Abramowitz L, Soudan D, Souffran M, Bouchard D, Castinel A, Suduca JM, Staumont G, Devulder F, Pigot F, Ganansia R, Varastet M. The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study. Colorectal Dis 2016; 18:279-85. [PMID: 26382623 DOI: 10.1111/codi.13121] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/03/2015] [Indexed: 12/21/2022]
Abstract
AIM The study aimed to evaluate outcome at 1 year of one- and two-stage fistulotomy for anal fistula in a large group of patients. METHOD A prospective multicentre observational study was designed to include patients with anal fistula treated by one- or two-stage fistulotomy. Data were collected using a self-administered questionnaire before surgery, during healing and at 1 year after surgery. RESULTS Group A (133 patients) with a low anal fistula underwent a one-stage fistulotomy. The median Wexner scores before and after surgery were 1.0 (0-11) and 2.0 (0-18) (P = 0.032) and the median Vaizey scores were 2.0 (0-14) and 3.0 (0-21) (P = 0.055). The Wexner scores and percentage of patients before and after fistulotomy were as follows: 0-5: 88%, 86%; 6-10: 10.7%, 10.7%; 11-15: 1.0%, 2.6%; and 16-20: 0%, 2%. Eighty-seven per cent of the patients were satisfied. Group B (62 patients) underwent two-stage fistulotomy for a high transsphincteric fistula. The Wexner scores and percentage of patients before the first stage and 1 year after the second stage were as follows: 0-5: 86%, 66%; 6-10: 4.5%, 20%; 11-15: 9%, 11%; and 16-20: 0%, 2%. The median Wexner scores before the first stage and after the second stage were 1 (0-14) vs. 4 (0-19) (P < 0.001), and the median Vaizey scores were 1.5 (0-11) vs. 4 (0-20) (P < 0.001). Eighty-eight per cent of the patients were satisfied. CONCLUSION Low transsphincteric anal fistula can be treated by fistulotomy without clinically significant continence disturbance. Treating high transsphincteric anal fistulae with two-stage fistulotomy is followed by mild continence disturbance. Satisfaction rates were high.
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Affiliation(s)
- L Abramowitz
- Proctologie Médico-Chirurgicale, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - D Soudan
- Institut de Proctologie Léopold Bellan, Hôpital Saint Joseph, Paris, France
| | - M Souffran
- Service de Proctologie, Clinique Saint Augustin, Nantes, France
| | - D Bouchard
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - A Castinel
- Clinique Théodore Ducos, Bordeaux, France
| | - J M Suduca
- Service de Proctologie, Clinique St Jean Languedoc, Toulouse, France
| | - G Staumont
- Service de Proctologie, Clinique St Jean Languedoc, Toulouse, France
| | | | - F Pigot
- Service de Proctologie, Hôpital Bagatelle, Talence, France
| | - R Ganansia
- Institut de Proctologie Léopold Bellan, Hôpital Saint Joseph, Paris, France
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16
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Senéjoux A, Siproudhis L, Abramowitz L, Munoz-Bongrand N, Desseaux K, Bouguen G, Bourreille A, Dewit O, Stefanescu C, Vernier G, Louis E, Grimaud JC, Godart B, Savoye G, Hebuterne X, Bauer P, Nachury M, Laharie D, Chevret S, Bouhnik Y. Fistula Plug in Fistulising Ano-Perineal Crohn's Disease: a Randomised Controlled Trial. J Crohns Colitis 2016; 10:141-8. [PMID: 26351393 DOI: 10.1093/ecco-jcc/jjv162] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/26/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Anal fistula plug [AFP] is a bioabsorbable bioprosthesis used in ano-perineal fistula treatment. We aimed to assess efficacy and safety of AFP in fistulising ano-perineal Crohn's disease [FAP-CD]. METHODS In a multicentre, open-label, randomised controlled trial we compared seton removal alone [control group] with AFP insertion [AFP group] in 106 Crohn's disease patients with non- or mildly active disease having at least one ano-perineal fistula tract drained for more than 1 month. Patients with abscess [collection ≥ 3mm on magnetic resonance imaging or recto-vaginal fistulas were excluded. Randomisation was stratified in simple or complex fistulas according to AGA classification. Primary end point was fistula closure at Week 12. RESULTS In all, 54 patients were randomised to AFP group [control group 52]. Median fistula duration was 23 [10-53] months. Median Crohn's Disease Activity Index at baseline was 81 [45-135]. Fistula closure at Week 12 was achieved in 31.5% patients in the AFP group and in 23.1 % in the control group (relative risk [RR] stratified on AGA classification: 1.31; 95% confidence interval: 0.59-4.02; p = 0.19). No interaction in treatment effect with complexity stratum was found; 33.3% of patients with complex fistula and 30.8% of patients with simple fistula closed the tracts after AFP, as compared with 15.4% and 25.6% in controls, respectively [RR of success = 2.17 in complex fistula vs RR = 1.20 in simple fistula; p = 0.45]. Concerning safety, at Week 12, 17 patients developed at least one adverse event in the AFP group vs 8 in the controls [p = 0.07]. CONCLUSION AFP is not more effective than seton removal alone to achieve FAP-CD closure.
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Affiliation(s)
- A Senéjoux
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
| | - L Siproudhis
- Hôpital Pontchaillou, Université Rennes 1, Rennes, France
| | - L Abramowitz
- Hôpital Bichat, Université Diderot Paris 7, Paris, France
| | | | - K Desseaux
- Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis, Université Diderot Paris 7, Paris, France
| | - G Bouguen
- Hôpital Pontchaillou, Université Rennes 1, Rennes, France
| | - A Bourreille
- Institut des Maladies de l'Appareil Digestif, CHU Nantes, Nantes, France
| | - O Dewit
- Clinique Universitaire Saint Luc, Bruxelles, Belgique
| | - C Stefanescu
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
| | - G Vernier
- Hôpital Claude Huriez, Université Lille 2, Lille, France
| | - E Louis
- CHU Sart Tilman, Université de Liège, Liège, Belgique
| | - J C Grimaud
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | | | - G Savoye
- Hôpital Charles Nicolle, Université de Rouen UR, Rouen, Franc
| | - X Hebuterne
- Hôpital de l'Archet, Université Nice Sophia-Antipolis, Nice, France
| | - P Bauer
- GH Diaconesses-Croix Saint-Simon, Paris, France
| | - M Nachury
- Hôpital Jean Minjoz, Université de Franche-Comté, Besançon, France
| | - D Laharie
- Hôpital Sud, Université Bordeaux Segalen, Bordeaux, France
| | - S Chevret
- Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis, Université Diderot Paris 7, Paris, France
| | - Y Bouhnik
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
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Vitton V, Soudan D, Siproudhis L, Abramowitz L, Bouvier M, Faucheron JL, Leroi AM, Meurette G, Pigot F, Damon H. Treatments of faecal incontinence: recommendations from the French national society of coloproctology. Colorectal Dis 2014; 16:159-66. [PMID: 24521273 DOI: 10.1111/codi.12410] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/09/2013] [Indexed: 12/13/2022]
Abstract
Faecal incontinence is common and significantly affects quality of life. Its treatment involves dietary manipulation, medical treatments, perineal rehabilitation or surgery. In this paper, the French National Society of Coloproctology offers recommendations based on the data in the current literature, including those on recently developed treatments. There is a lack of high quality data and most of the recommendations are therefore based either on grade of recommendation B or expert recommendation (Level 4). However, the literature supports the construction of an algorithm based on the available scientific evidence and expert recommendation which may be useful in clinical practice. The French National Society of Coloproctology proposes a decision-making algorithm that includes recent developments of treatment. The current recommendations support sacral nerve modulation as the key treatment for faecal incontinence. They do not support the use of sphincter substitutions except in certain circumstances. Transanal irrigation is a novel often successful treatment of faecal incontinence due to neurological disorders.
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Affiliation(s)
- V Vitton
- Service de Gastroentérologie, Hôpital Nord, AP-HM, Interface de recherche translationnelle en neurogastroentérologie, CRN2M, UMR 7286, Aix-Marseille Université, Marseille, France
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Abramowitz L, Béziaud N, Caussé C, Chuberre B, Allaert FA, Perrot S. Further validation of the psychometric properties of the Bowel Function Index for evaluating opioid-induced constipation (OIC). J Med Econ 2013; 16:1434-41. [PMID: 24102611 DOI: 10.3111/13696998.2013.851083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The BFI † (Bowel Function Index) is a 3-item questionnaire for assessing opioid-induced constipation (OIC). The aim of this study was to contribute to the validation of the psychometric properties of the BFI by confirming a constipation threshold, and through correlation with other validated tools: KESS (Knowles Eccersley Scott Symptom) score and generic (12-Item Short Form Health Survey, SF-12) and specific (Patient Assessment of Constipation-Quality of Life, PAC-QoL *) quality-of-life scores. METHODS A survey on opioid-requiring cancer-patients was carried out in France. A questionnaire was filled out for all patients that recorded their demographic characteristics, an assessment of their constipation using BFI and KESS scores, and included a self-assessment of quality-of-life using PAC-QoL and SF-12. Correlation of BFI with KESS, PAC-QoL, and SF-12 was investigated. RESULTS Five hundred and twenty patients participated in the entire data collection with no loss. BFI was shown to be statistically correlated (r = 0.571; p < 0.0001) with the KESS score and matches up with PAC-QoL and to a lesser extent with the SF-12 generic quality-of-life questionnaire. A BFI threshold of 27-29 to discriminate constipated from non-constipated patients was confirmed. KEY LIMITATIONS This cross-sectional study in a selected population of cancer pain patients has validated the psychometric properties of the BFI. Further confirmation of the validity of the BFI could be sought through the use of longitudinal studies, and larger populations, such as non-cancer pain patients treated with opioids. CONCLUSION This study contributes to the validation of the psychometric properties of the BFI. It confirms the BFI as an easy-to-use tool to assess constipation and its impact on quality-of-life in chronic pain patients.
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Abramowitz L, Béziaud N, Labreze L, Giardina V, Caussé C, Chuberre B, Allaert FA, Perrot S. Prevalence and impact of constipation and bowel dysfunction induced by strong opioids: a cross-sectional survey of 520 patients with cancer pain: DYONISOS study. J Med Econ 2013; 16:1423-33. [PMID: 24102123 DOI: 10.3111/13696998.2013.851082] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the prevalence of opioid-induced constipation (OIC) in patients with cancer pain according to the Knowles-Eccersley-Scott symptom score (KESS), the different symptoms of opioid-induced bowel dysfunction (OIBD), and to assess the impact of OIBD on patient's quality-of-life. METHODS A cross-sectional observational study, using the KESS questionnaire and the physician's subjective assessment of constipation, and other questionnaires and questions on constipation, OIBD, and quality-of-life, carried out on 1 day at oncology day centres and hospitals. RESULTS Five hundred and twenty patients were enrolled at 77 centres in France; 61.7% of patients (n = 321) showed a degree of constipation that is problematic for the patient according to KESS (between 9-39). Even more patients, 85.7% (n = 438), were considered constipated according to the physician's subjective assessment-despite laxative use (84.7% of patients). Quality-of-life was significantly reduced in constipated vs non-constipated patients for both PAC-QoL (p < 0.0001 for total score and each dimension) and the SF-12 questionnaires (statistically significant for all dimensions except physical state and role physical). OIC and OIBD led to hospitalization (16% of patients), pain (75% of patients), and frequent changes in opioid and laxative treatment. KEY LIMITATIONS This cross-sectional study, in a selected population of cancer patients, has measured prevalence and impact of OIBD. Further confirmation could be sought through the use of longitudinal studies, and larger populations, such as non-cancer pain patients treated with opioids. CONCLUSIONS Cancer patients taking opioids for pain are very frequently constipated, even if they are prescribed laxatives. This leads to relevant impairments of quality-of-life.
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Bouchard D, Abramowitz L, Castinel A, Suduca JM, Staumont G, Soudan D, Devulder F, Pigot F, Varastet M, Ganansia R. One-year outcome of haemorrhoidectomy: a prospective multicentre French study. Colorectal Dis 2013; 15:719-26. [PMID: 23216822 DOI: 10.1111/codi.12090] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/14/2012] [Indexed: 12/13/2022]
Abstract
AIM An evaluation was performed of the 1-year outcome of open haemorrhoidectomy (Milligan and Morgan alone or with posterior mucosal anoplasty [the Leopold Bellan procedure]). METHOD A prospective, multicentre, observational study included all patients having a planned haemorrhoidectomy from January 2007 to June 2008. Data were collected before surgery, and at 3 months and 1 year after surgery. Patients assessed their anal symptoms and quality of life (SF-36). RESULTS Six-hundred and thirty-three patients (median age = 48 years, 56.5% women) underwent haemorrhoidectomy either by the Milligan and Morgan procedure alone (n = 231, 36.5%) or together with the Leopold Bellan procedure (posterior mucosal anoplasty) for resection of a fourth haemorrhoid (n = 345, 54.5%), anal fissure (n = 56, 8.9%) or low anal fistula (n = 1, 0.16%). The median healing time was 6 weeks. Early complications included urinary retention (n = 3), bleeding (n = 11), local infection (n = 7) and faecal impaction (n = 9). At 1 year, the main complications included skin tags (n = 2) and anal stenosis (n = 23). There were three recurrences requiring a second haemorrhoidectomy. On a visual analogue scale, anal pain at 1 year had fallen from a median of 5.5/10 before treatment to 0.1/10 (p < 0.001), anal discomfort from 5.5/10 to 0.1/10 (P < 0.001) and the Knowles-Eckersley-Scott Symptom (KESS) constipation score from 9/45 to 6/45 (P < 0.001). The median Wexner score for anal incontinence was unchanged (2/20). De-novo anal incontinence (a Wexner score of >5) affected 8.5% of patients at 1 year, but preoperative incontinence disappeared in 16.7% of patients with this symptom. All physical and mental domains of quality of life significantly improved, and 88% of patients were satisfied or very satisfied. CONCLUSION Complications of open haemorrhoidectomy were infrequent. Anal continence was not altered. Comfort and well-being were significantly improved at 1 year after surgery. Patient satisfaction was high despite residual anal symptoms.
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Affiliation(s)
- D Bouchard
- Service de Proctologie, Hôpital Bagatelle, Talence, France.
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Abramowitz L, Bouchard D, Souffran M, Devulder F, Ganansia R, Castinel A, Suduca JM, Soudan D, Varastet M, Staumont G. Sphincter-sparing anal-fissure surgery: a 1-year prospective, observational, multicentre study of fissurectomy with anoplasty. Colorectal Dis 2013; 15:359-67. [PMID: 22776322 DOI: 10.1111/j.1463-1318.2012.03176.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM Internal sphincterotomy is the standard surgical treatment for chronic anal fissure, but is frequently complicated by anal incontinence. Fissurectomy is proposed as an alternative technique to avoid sphincter injury. We describe 1-year outcomes of fissurectomy. METHOD This was a prospective, multicentre, observational study. All patients with planned surgery for chronic anal fissure were included and had fissurectomy. Data were collected before surgery, at healing, and 1 year after fissurectomy. Patient self-assessed anal symptoms and quality of life (using the 36-item short-form health survey [SF-36] questionnaire). Presurgical and postsurgical variables were compared using the Wilcoxon signed-rank test for paired samples. RESULTS Two-hundred and sixty-four patients were included (median age, 45 years; 52% women). Anoplasty was associated with fissurectomy in 83% of the 257 documented cases. The main complications were urinary retention (n = 3), local infection (n = 4) and faecal impaction (n = 1). Healing was achieved in all patients at a median of 7.5 weeks after surgery. No recurrence occurred. At 1 year, 210 (79%) questionnaires were returned. Median anal pain had dropped from 7.3/10 to 0.1/10 (P < 0.001), anal discomfort had decreased from 5.0/10 to 0.1/10 (P < 0.001) and the Knowles-Eckersley-Scott Symptom constipation score had decreased from 9/45 to 5/45 (P < 0.001). There was a nonsignificant increase in the Wexner anal incontinence score, from 1/20 to 2/20. De-novo clinically significant anal incontinence (Wexner score > 5) affected 7% of patients at 1 year, but presurgical incontinence had disappeared in 15% of patients. All SF-36 domains significantly improved. Anoplasty did not impact any result. CONCLUSION Given its high rate of healing and low rate of de-novo anal incontinence, fissurectomy with anoplasty is a valuable sphincter-sparing surgical treatment for chronic anal fissure.
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Affiliation(s)
- L Abramowitz
- Unité de Proctologie Médico-Chirurgicale, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.
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Queralto M, Badiou W, Bonnaud G, Abramowitz L, Tanguy Le Gac Y, Monrozies X. Traitement des fistules recto-vaginales de la maladie de Crohn par lambeau d’avancement vaginal. ACTA ACUST UNITED AC 2012; 40:143-7. [DOI: 10.1016/j.gyobfe.2011.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 12/02/2010] [Indexed: 01/22/2023]
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Borget I, Abramowitz L, Mathevet P. Economic burden of HPV-related cancers in France. Vaccine 2011; 29:5245-9. [PMID: 21616117 DOI: 10.1016/j.vaccine.2011.05.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/14/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
Human papillomavirus (HPV) infection is associated with a range of diseases and cancers at different anatomical sites. In addition to its role as a necessary cause of cervical cancer, HPV is also associated with cancers of the vulva, vagina, anus, penis, head and neck. With the exception of cervical cancer, however, very few data are available on the economic burden of HPV-associated cancers. We assessed the annual costs associated with management of HPV-related cancers in France from the healthcare payers' perspective. We used data from studies that employed similar methodologies to estimate the costs during 2006 for cervical cancer, vulvar and vaginal cancers, anal cancer, and penile cancer, and during 2007 for head and neck cancers. Data on hospital-management costs for cancer were derived from the French national hospital database. The costs of outpatient care and daily allowance costs were estimated using data from the French National Institute of Cancer report for 2007. The costs for HPV-related cancers were estimated according to the percentage of each cancer type attributable to HPV infection. The estimated total costs associated with HPV-related cancers in France were €239.7 million. The overall costs in men were €107.2 million, driven mainly by head and neck cancers (€94.6 million). The total costs in women were €132.5 million, due mainly to invasive cervical cancer (€83.9 million). The costs associated with HPV-related cancers are important to consider when evaluating the overall benefits of HPV vaccination in males and females.
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Affiliation(s)
- I Borget
- Gustave Roussy Institute, Villejuif, France.
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24
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Piketty C, Lanoy E, Si-Mohamed A, Cochand-Priolet B, Trabelsi S, Girard PM, Tubiana R, Abramowitz L, Tartour E, Rouzioux C, Weiss L, Costagliola D. Persistence of anal squamous intraepithelial lesions and anal HPV infection in HIV-infected patientsdespite immune restoration under cART. Infect Agent Cancer 2010. [PMCID: PMC3002720 DOI: 10.1186/1750-9378-5-s1-a59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abramowitz L, Rémy V, Vainchtock A. Economic burden of anal cancer management in France. Rev Epidemiol Sante Publique 2010; 58:331-8. [DOI: 10.1016/j.respe.2010.06.165] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 01/14/2010] [Accepted: 06/03/2010] [Indexed: 12/01/2022] Open
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Abramowitz L, Weyandt GH, Havlickova B, Matsuda Y, Didelot JM, Rothhaar A, Sobrado C, Szabadi A, Vitalyos T, Wiesel P. The diagnosis and management of haemorrhoidal disease from a global perspective. Aliment Pharmacol Ther 2010; 31 Suppl 1:1-58. [PMID: 20500735 DOI: 10.1111/j.1365-2036.2010.04278.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- L Abramowitz
- AP-HP Bichat University Hospital, Paris, France.
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Guyot A, Begon E, Abramowitz L, Landry J, Marinho E, Descamps V, Crickx B. Infection cutanée aiguë et nécrosante à Mycobacterium marinum chez un patient traité par infliximab pour une maladie de Crohn. Ann Dermatol Venereol 2009; 136:806-10. [DOI: 10.1016/j.annder.2009.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 09/11/2009] [Indexed: 10/20/2022]
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Abramowitz L, Mathieu N, Roudot-Thoraval F, Lemarchand N, Bauer P, Hennequin C, Mitry E, Romelaer C, Aparicio T, Sobhani I. Epidermoid anal cancer prognosis comparison among HIV+ and HIV- patients. Aliment Pharmacol Ther 2009; 30:414-21. [PMID: 19392867 DOI: 10.1111/j.1365-2036.2009.04026.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Previous studies suggest a poor prognosis of epidermoid anal cancer in HIV+ patients. AIM To investigate the long-term outcome of epidermoid anal cancer in HIV+ and HIV- patients in the highly active antiretroviral treatment (HAART) era. METHODS We included all patients with epidermoid anal cancer referred to six hospitals from 1998 to 2004. RESULTS In all, 151 patients (44 HIV+, 107 HIV-) were reviewed retrospectively for 27 (median of 16-44) months. HIV+ patients were male (100% vs. 27%, P < 0.001) and younger (45 vs. 62 years old, P < 0.001) than HIV- patients. No significant differences were observed in the tumour stage, pelvic radiotherapy dose or concomitant chemotherapy, according to the HIV status. After chemoradiotherapy, similar numbers of HIV+ and HIV- patients had grade III-IV toxicity. A complete response was obtained in 82% and 75% (N.S.) of cases, respectively. The disease-free survival rates were 77% and 67% (N.S.) and the overall survival rates were 85% and 84% (N.S.), respectively, after 3 years of follow-up. Duration of HIV infection, viral load and CD4 count had no effect on the survival rate of HIV+ patients with EAC. CONCLUSIONS The clinical outcome of HIV+ patients with epidermoid anal cancer is similar to that of HIV- patients. Therefore, the same therapeutic guidelines should be applied to both populations.
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Affiliation(s)
- L Abramowitz
- AP-HP, Service de gastroentérologie et Unité de proctologie medico-chirurgicale, Hôpital Universitaire Bichat, Paris, CEDEX, France.
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30
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Mathieu N, Aparicio T, Roudot-Thoraval F, Lemarchand N, Bauer P, Hennequin C, Mitry E, Romelaer C, Abramowitz L, Sobhani I. Comparison of squamous cell carcinoma of the canal anal (SCCA) prognosis in patients infected or not by human immunodeficiency virus (HIV). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4632 Background: Incidence of SCCA is increasing promoted by HIV infection. Previous small series of SCCA revealed a worst prognosis in HIV+ than in HIV- patients. Few data are available since the use of highly active antiretroviral therapy (HAART) in HIV patients. The aim of the study was to compare clinical outcome of patients recently treated for SCCA according to HIV status. Methods: Retrospective study in 6 hospitals. all consecutive patients treated for SCCA from January 1998 to October 2004 were included. Clinical outcome and pattern of care according to HIV status were compared. Results: 151 patients were included, 44 (29%) of them were HIV infected. Median follow-up was 27 (16–44) months. HIV+ patients were youngest (45 vs 62 years old, p<0.001) and only male (100% vs 27%, p<0.001). There were no significant difference in tumor stage I : 37.5 vs 25%, II : 48 vs 42.5%, IIIa : 7.5 vs 16.5%, IIIb : 12.5 vs 5% and IV : 0 vs 6% according to HIV+ or HIV- respectively. The treatments performed in HIV+ and HIV- patients were: Pelvic radiotherapy in 86 vs 91% (ns) delivering a median dose of 48 and 46 Gray. A boost in reduced fields or brachytherapy was performed in 58% vs 64% (ns). Concomitant chemotherapy (5-fluorouracile and cisplatin) was administered in 52% vs 56% (ns). Dose intensity of 5-fluorouracile and cisplatin was similar in both group. Grade 3–4 toxicity of chemoradiotherapy was observed in 11% vs 10% (ns). Complete response was obtained in 82 vs 75% (ns) and surgery (colostomy or abdominoperineal resection) was performed in 2.4% vs 7.6% of the patients (ns). During the follow-up local or metastatic recurrence occurred in 32% vs 22% of the patients (ns). The 3 years disease free survival were 77% vs 67% (ns) and 3 years overall survival were 85% and 84% (ns). Among HIV+ patients, 42/44 were on HAART, the survival was not modified by the duration of infection, viral load and CD4 count. Conclusions: The clinical outcome of HIV+ patients with SCCA is now similar to HIV- patients. The same therapeutic guidelines should be applied in both population. This improvement of prognosis is probably due to extensive use of HAART in HIV+ patients. No significant financial relationships to disclose.
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Affiliation(s)
- N. Mathieu
- Hôpital Bichat, Paris, France; Hôpital Henri Mondor, Créteil, France; Hôpital Leopold Bellan, Paris, France; Hôpital des Diaconesses, Paris, France; Hôpital Saint Louis, Paris, France; Hôpital Ambroise Paré, Boulogne, France; Hôpital Max Fourestier, Nanterre, France
| | - T. Aparicio
- Hôpital Bichat, Paris, France; Hôpital Henri Mondor, Créteil, France; Hôpital Leopold Bellan, Paris, France; Hôpital des Diaconesses, Paris, France; Hôpital Saint Louis, Paris, France; Hôpital Ambroise Paré, Boulogne, France; Hôpital Max Fourestier, Nanterre, France
| | - F. Roudot-Thoraval
- Hôpital Bichat, Paris, France; Hôpital Henri Mondor, Créteil, France; Hôpital Leopold Bellan, Paris, France; Hôpital des Diaconesses, Paris, France; Hôpital Saint Louis, Paris, France; Hôpital Ambroise Paré, Boulogne, France; Hôpital Max Fourestier, Nanterre, France
| | - N. Lemarchand
- Hôpital Bichat, Paris, France; Hôpital Henri Mondor, Créteil, France; Hôpital Leopold Bellan, Paris, France; Hôpital des Diaconesses, Paris, France; Hôpital Saint Louis, Paris, France; Hôpital Ambroise Paré, Boulogne, France; Hôpital Max Fourestier, Nanterre, France
| | - P. Bauer
- Hôpital Bichat, Paris, France; Hôpital Henri Mondor, Créteil, France; Hôpital Leopold Bellan, Paris, France; Hôpital des Diaconesses, Paris, France; Hôpital Saint Louis, Paris, France; Hôpital Ambroise Paré, Boulogne, France; Hôpital Max Fourestier, Nanterre, France
| | - C. Hennequin
- Hôpital Bichat, Paris, France; Hôpital Henri Mondor, Créteil, France; Hôpital Leopold Bellan, Paris, France; Hôpital des Diaconesses, Paris, France; Hôpital Saint Louis, Paris, France; Hôpital Ambroise Paré, Boulogne, France; Hôpital Max Fourestier, Nanterre, France
| | - E. Mitry
- Hôpital Bichat, Paris, France; Hôpital Henri Mondor, Créteil, France; Hôpital Leopold Bellan, Paris, France; Hôpital des Diaconesses, Paris, France; Hôpital Saint Louis, Paris, France; Hôpital Ambroise Paré, Boulogne, France; Hôpital Max Fourestier, Nanterre, France
| | - C. Romelaer
- Hôpital Bichat, Paris, France; Hôpital Henri Mondor, Créteil, France; Hôpital Leopold Bellan, Paris, France; Hôpital des Diaconesses, Paris, France; Hôpital Saint Louis, Paris, France; Hôpital Ambroise Paré, Boulogne, France; Hôpital Max Fourestier, Nanterre, France
| | - L. Abramowitz
- Hôpital Bichat, Paris, France; Hôpital Henri Mondor, Créteil, France; Hôpital Leopold Bellan, Paris, France; Hôpital des Diaconesses, Paris, France; Hôpital Saint Louis, Paris, France; Hôpital Ambroise Paré, Boulogne, France; Hôpital Max Fourestier, Nanterre, France
| | - I. Sobhani
- Hôpital Bichat, Paris, France; Hôpital Henri Mondor, Créteil, France; Hôpital Leopold Bellan, Paris, France; Hôpital des Diaconesses, Paris, France; Hôpital Saint Louis, Paris, France; Hôpital Ambroise Paré, Boulogne, France; Hôpital Max Fourestier, Nanterre, France
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Abramowitz L, Benabderrahmane D, Bouvet E, Duval X. Prévalence des condylomes anaux chez les patients infectés par le VIH. Med Mal Infect 2005; 35:299-301. [PMID: 15885954 DOI: 10.1016/j.medmal.2005.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Accepted: 02/18/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the general HIV-infected population, there are few data on the prevalence and risk factors for anal condyloma, precursor lesions for anal cancer. METHODS Screening for perianal and endoanal condyloma with an anoscopy was systematically proposed to 516 consecutive outpatients, followed in a university hospital in Paris. For each point, HIV characteristics and sexual behaviors assessed through semi-directive questionnaire were collected. FINDINGS The 473 (92%) examined patients, consisted of 200 homosexual men, 123 heterosexual men, 150 women; 76% were receiving HAART, HIV-RNA was<50 copies/ml in 60%, mean (+/-SD) CD4 cell count were 484 (+/-274)/mm(3). Overall, 108 (23%) pts had histologically-confirmed anal condyloma (36, 15 and 11% of the respective populations), including 51 (47%) pts with only endoanal localisation. Intraepithelial neoplasia of grade I was noted in 59 patients, of grade II in 10 and of grade III in 2 and an invasive endoanal cancer in 1. In multivariate regression analysis, condyloma independent risk factor were history of gonococcia or syphilis (OR=0.54 (0.29-0.99)), and history of previous anal condyloma (OR=2.05 (1.07-3.92) in homosexual men, history of previous penis condyloma (OR=26.8 (2.3-309.6), and unprotected sexual intercourse (OR=7.5 (2.1-26.3)) in heterosexual men and CD4 cell count below 200/mm(3), (OR=8.9 (1.5-51.6)), receptive anal intercourse (OR=6.7 (1.7-25.8)) and history of previous anal condyloma (OR=25.4 (3.4-188.2)) in women. INTERPRETATION In the HAART era, systematic screening revealed a high rate of anal condyloma in all HIV positive pts (not only in homosexual men). Anal examination should be proposed systematically to all HIV-infected patients.
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Affiliation(s)
- L Abramowitz
- Unité de proctologie médicochirurgicale de l'hôpital Bichat-Claude-Bernard, 46 rue Henri-Huchard, 75018 Paris, France.
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Abramowitz L. [Crohn's disease and pregnancy. About 34 cases. Review of the literature. Gynecol Obstet Fertil 2003 ; 31: 20-28]. ACTA ACUST UNITED AC 2003; 31:687-8; author reply 688-9. [PMID: 14563615 DOI: 10.1016/s1297-9589(03)00192-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abramowitz L, Batallan A. [Epidemiology of anal lesions (fissure and thrombosed external hemorroid) during pregnancy and post-partum]. Gynecol Obstet Fertil 2003; 31:546-9. [PMID: 12865195 DOI: 10.1016/s1297-9589(03)00127-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Thrombosed external hemorrhoids (TEH) and anal fissure (AF) are 2 frequent sources of anal pains during childbirth. We are going to define their incidences as available in publications and in our experience in Bichat hospital. Then we will define their risk factors. According to Martin's and Corby's studies, AF was observed in 10% of the delivered women. In Bichat hospital we performed a proctological assessment to 165 pregnant women during the last third of pregnancy and within the 2 months following delivery. We observed 2 AF (1,2%) during the first period and 25 (15,2%) during the second. Rouillon et al. reported an incidence of TEH in 12,2% (20/164), while Pradel and al. reported 34% (18/52) of it. In Bichat hospital, 13 women (7,9%) were presenting with TEH during the last third of pregnancy and 33 (20%) in post-partum period. Two studies looked for a statistical correlation between AF and obstetrical, foetal or maternal factors. Corby et al. only pointed the role of constipation. In our study, terminal constipation was the most important risk factor for AF with 5.7 (2.7-12), odds ratio (95% confidence intervals). Rouillon et al. observed more TEH among women with a prolonged first stage labor and a big baby. In our study, a big baby and mother little lips tears were observed more often among women with TEH (P <0,05). Also, we observed only one TEH among the 25 women with caesarean section (4%). Finally, observation that TEH arise immediately after delivery is another argument to support the role of traumatic delivery. We also demonstrated the role of terminal constipation as risk factor for TEH after delivery. To conclude, 1/3 of pregnant women develop AF or TEH after delivery. These 2 pathologies are strongly correlated to terminal constipation. TEH seems equally furthered by traumatic delivery.
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Affiliation(s)
- L Abramowitz
- Service de gastro-entérologie et Famya de coloproctologie, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
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Descamps V, Mahe E, Houhou N, Abramowitz L, Rozenberg F, Ranger-Rogez S, Crickx B. Drug-induced hypersensitivity syndrome associated with Epstein-Barr virus infection. Br J Dermatol 2003; 148:1032-4. [PMID: 12786838 DOI: 10.1046/j.1365-2133.2003.05330.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Association of drug-induced hypersensitivity syndrome with viral infection is debated. Human herpesvirus 6 (HHV-6) reactivation has been the most frequently reported infection associated with this syndrome. However, a case of cytomegalovirus (CMV) infection was recently described associated with anticonvulsant-induced hypersensitivity syndrome. We report a case of severe allopurinol-induced hypersensitivity syndrome with pancreatitis associated with Epstein-Barr virus (EBV) infection. Active EBV infection was demonstrated in two consecutive serum samples by the presence of anti-EBV early antigen (EA) IgM antibodies and an increase in anti-EBV EA IgG antibodies, whereas no anti-EBV nuclear antigen IgG antibodies were detected. EBV DNA was detected by polymerase chain reaction (PCR) in peripheral blood mononuclear cells. Reactivation of HHV-6 was suggested only by the presence of anti-HHV-6 IgM antibodies, but HHV-6 DNA was not detected by PCR in the serum. Other viral investigations showed previous infection (CMV, rubella, measles, parvovirus B19), immunization after vaccination (hepatitis B virus), or absence of previous infection (hepatitis C virus, human immunodeficiency virus). We suggest that EBV infection may participate in some cases, as do the other herpesviruses HHV-6 or CMV, in the development of drug-induced hypersensitivity syndrome.
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Affiliation(s)
- V Descamps
- Department of Dermatology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France.
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Abramowitz L, Godeberge P, Staumont G, Soudan D. [Recommendations for the treatment of hemorrhoidal disease in clinical practice]. Gynecol Obstet Fertil 2001; 29:942-51. [PMID: 11802559 DOI: 10.1016/s1297-9589(01)00246-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abramowitz L, Godeberge P, Staumont G, Soudan D. [Clinical practice guidelines for the treatment of hemorrhoid disease]. Gastroenterol Clin Biol 2001; 25:674-702. [PMID: 11673735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Abramowitz L, Sobhani I, Ganansia R, Vuagnat A, Benifla JL, Darai E, Madelenat P, Mignon M. Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study. Dis Colon Rectum 2000; 43:590-6; discussion 596-8. [PMID: 10826416 DOI: 10.1007/bf02235567] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Anal incontinence affects approximately 10 percent of adult females. Damage to the anal sphincters has been considered as the cause of anal incontinence after childbirth in the sole prospective study so far available. The aims of the present study were to determine prospectively the incidence of anal incontinence and anal sphincter damage after childbirth and their relationship with obstetric parameters. METHODS We studied 259 consecutive females six weeks before and eight weeks after delivery. They were asked to fill in a questionnaire assessing fecal incontinence. Anal endosonography (7-10 MHz) was then performed. Two independent observers analyzed internal and external anal sphincters. RESULTS A total of 233 patients (90 percent) were assessed, of whom 31 had cesarean section. De novo sphincter defects were observed in 16.7 percent (14 percent external, 1.7 percent internal, and 1 percent both) in the postpartum period only after vaginal delivery. These disruptions occurred with the same incidence after the first and the second childbirth. Independent risk factors (odds ratio; 95 percent confidence interval) for sphincter defect were forceps (12; 4-20), perineal tears (16; 9-25), episiotomy (6.6; 5-17), and parity (8.8; 4-19) as revealed by multivariate analyses. The overall rate of anal incontinence was 9 percent and independent risk factors (odds ratio; 95 percent confidence interval) involved forceps (4.5; 1.5-13), perineal tears (3.9; 1.4-10.9), sphincter defect (5.5; 5-15), and prolonged labor (3.4; 1-11). Among these patients only 45 percent had sphincter defects. CONCLUSION Anal incontinence after delivery is multifactorial, and anal sphincter defects account for only 45 percent of them. Primiparous and secundiparous patients have the same risk factors for sphincter disruption and anal incontinence. Because external anal sphincter disruptions are more frequent than internal anal sphincter damage, surgical repair should be discussed in symptomatic patients.
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Affiliation(s)
- L Abramowitz
- Fama de Coloproctologie, Hôpital Bichat-Claude Bernard Paris, France
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Benifla JL, Abramowitz L, Sobhani I, Ganansia R, Darai E, Mignon M, Madelenat P. [Postpartum sphincter rupture and anal incontinence: prospective study with 259 patients]. Gynecol Obstet Fertil 2000; 28:15-22. [PMID: 10774113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
AIMS Damage to the anal sphincter has been considered as the cause of anal incontinence after childbirth. The aims of the present study were to determine prospectively the incidence of anal incontinence and anal sphincter damage after childbirth, and their relationship with obstetric parameters in France. PATIENTS AND METHODS We studied 259 consecutive women six weeks before and eight weeks after delivery. They were asked to fill out a questionnaire dealing with faecal and urinary incontinence. Anal endosonography (B&K 7-10 MHz) was then performed. Two independent observers analyzed internal and external anal sphincters. RESULTS Two hundred and thirty-three women (90%) were assessed, among whom 31 had had a caesarean section. De novo sphincter defects were observed in 19.3% (39 patients) in the postpartum period only after vaginal delivery (202 patients). These disruptions occurred with the same incidence after the first and second childbirth. Independent risk factors (odds ratio; 95% confidence interval) for sphincter defect were forceps (odds ratio 11.9; 4.8-33.3), perineal tears (odds ratio 16.1; 4.4-83.9), episiotomy (odds ratio 6.6; 1.7-34.2), and pauciparity < or = 2 (odds ratio 8.8; 1-78.3), as revealed by multivariate analyses. The overall rate of de novo anal incontinence was 9% (20 patients), and independent risk factors involved forceps (odds ratio 4.5; 1.5-13), perineal tears (odds ratio 3.9; 1.4-10.9), de novo sphincter defect (odds ratio 5.5; 5-15) and prolonged labor (odds ratio 3.4; 1-11). Among the 20 women who had de novo anal incontinence, only 45% (9 patients) had sphincter defects. CONCLUSION De novo anal incontinence after delivery is multifactorial and anal sphincter defects account only for 50% of them. Primiparous and secundiparous women have the same high-risk factor for sphincter disruption and anal incontinence. Since external anal sphincter disruptions are more frequent than internal anal sphincter damage, surgical repair should be discussed.
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Affiliation(s)
- J L Benifla
- Service de gynécologie-obstétrique, hôpital Bichat, Paris, France
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Abstract
Sarcoidosis is considered rarely in the differential diagnosis of scrotal masses. We report a case of epididymal sarcoid in an otherwise asymptomatic young man. The findings on the chest x-ray initially suggested a metastatic testicular neoplasm. Familiarity with this lesion may avert unnecessary orchiectomy. A rational treatment approach is presented and the literature is reviewed briefly.
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