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Ablation of Anal Lesions. (Clinical Capsules).

Ablative cautery done through a high-resolution anoscope seems to be a safe and effective--although painful--treatment for high-grade squamous intraepithelial lesions of the anus in HIV-negative patients. Effectiveness in HIV-infected people needs further study, according to Dr. George J. Chang of the University of California, San Francisco, and his associates.

Ablative surgery was used to treat large-volume anal high-grade squamous intraepithelial lesions (HSIL) in 37 men, including 29 who had HIV in this prospective safety study. After Lugol's solution was applied to the anal area, high-resolution anoscopy was used to identify tissue with HSIL for incisional biopsy followed by electrocautery ablation; patients with circumferential disease had a staged procedure to preserve perianal skin.

Uncontrolled pain of a mean duration of 3 weeks was reported by 16 of the 29 men who completed a telephone survey in the weeks after their surgery. No patient reported stenosis, incontinence, abscess, or bleeding; 21 of the 24 men who had practiced receptive anal intercourse before surgery were able to resume receptive anal intercourse after an average of 6 months (Dis. Colon Rectum 45[4]:453-58, 2002).

There was no recurrence of HSIL in the eight HIV-negative men during follow-up. However, HSIL recurred in 23 of the 29 HIV-positive men, with a mean time to recurrence of 12 months.
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Author:Kubetin, Sally Koch
Publication:Internal Medicine News
Article Type:Brief Article
Geographic Code:1USA
Date:Apr 15, 2002
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