Surgery Lecture Chest Wall Deformities胸壁畸形的小儿外科讲座课件.pptVIP

Perianal Paget’s disease- biopsy identify Paget’s cells APR for local failure of treatment Not easy Technical tips Fill the hole Tackle pelvic side wall involvement Sacral invasion Rectus abdominus flap Sidewall vessel involvement vessels Pelvic side wall BLEEDING Suture Fibrillar surgicell Argon beamer Be prepared to pack Direct invasion of the sacrum Choose level of sacrectomy carefully Frozen section Beware bleeding from pre-sacral veins APR+S vs TPE+S Questions Anal cancer is rare in the general population but high and growing in at-risk populations which are men who have sex with men regardless of HIV status. Women are considered at risk when they are HIV+, have a history of cervical dysplasia, vulvar cancer, or anal condyloma. Incidence rates as stated on the slide. * There are morphologic and biological similarities between AIN and CIN. There is a causal relationship link between high risk HPV and the development of anal carcinoma. HPV types 16/18 account for 85% of the cases. Gardasil vaccine has been approved to prevent anal cancer. There are no FDA approved test for anal HPV testing; however, some labs offer this type of testing off-label. The 2001 Bethesda guidelines includes an appendix for anal cytology. * ANAL CANCER OVERVIEW Rare in general population, but high and growing in at-risk populations1 Men who have sex with men (HIV+/-) Women (HIV) Incidence Rates2, 3 Men who have sex with men (MSM) HIV- 35/100,000 HIV+ est 70/100,000 General Population 1/100,000 Anal Cancer 2010 cases4 Cases Deaths Men 2,000 280 Women 3,260 440 Total 5,260 720 1 Bean, SM, Chhieng, DC, Anal-Rectal Cytology: A Review. Diagnostic Cytopathology 2009; Vol 38 No 7, 538-546 2 Palefsky, J. Screening for Anal and Cervical Dysplasia in HIV-Infected Patients. The PRN Notebook. Volume 6, No. 3, Sept. 2001. 24-31. 3 Darragh, TM. Anal Cytology for Anal Cancer Screening: Is it Time Yet? Diagnostic Cytopathology, 2004; Vol 30, No 6,