RESUMO
Lymphedema is the result of an alteration of the lymphatic drainage, and its most common worldwide cause is filariasis. In our practice usually is associated to neoplasic, inflammatory and granulomatous processes, radiotherapy, hydroelectrolytic disbalances, and idiopathic. It can affect any part of the body, including the penis and scrotum. The genital lymphedema is a rare presentation, it corresponds to 0.6% of lymphedema. However, causes serious functional, social and emotional limitations for the patient. Too often have pain, recurrent infections, sexual dysfunction, cosmetic deformity, sometimes it limits mobility and ambulation. Although there are several treatment options, both medical and surgical, it has not been found ideal for this disease. We present a 43 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa, it limits his normal activity. The patient was referred to our center after unsuccessful medical treatment (doxycycline and clindamycin cycles). Surgical treatment consisted of total excision of the skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. The result was satisfactory both functionally and aesthetically.
El linfedema es producto de una alteración en el drenaje linfático, y su causa más frecuente en todo el mundo es la filariasis. En nuestro medio suele encontrarse asociada a procesos neoplásicos, inflamatorios, granulomatosos, secuelas por radioterapia, desequilibrios hidroelectrolíticos y procesos idiopáticos. Puede afectar a cualquier parte del cuerpo, incluyendo el pene y el escroto. El linfedema genital es una presentación infrecuente, que corresponde al 0.6% de los linfedemas. No obstante, causa graves limitaciones funcionales, sociales y emocionales para el paciente. Con mucha frecuencia se presentan dolor, infecciones recurrentes, disfunción sexual y deformidad estética, llegando incluso a limitar la movilidad y la deambulación. Aunque existen varias opciones de tratamiento, tanto médico como quirúrgico, no se ha encontrado el ideal para esta enfermedad. Presentamos el caso de un paciente de 43 años afecto de hidrosadenitis axilar e inguinal que padece linfedema penoescrotal grave que limita seriamente su actividad habitual. El paciente fue remitido a nuestro centro tras el fracaso del tratamiento con antibióticos (ciclos de doxiciclina y clindamicina). El tratamiento quirúrgico consistió en la resección de piel y tejido celular subcutáneo hasta fascia de Buck y cobertura con injertos de piel. El resultado final fue adecuado desde un punto de vista tanto funcional como estético.
Assuntos
Hidradenite Supurativa/complicações , Linfedema/etiologia , Doenças do Pênis/etiologia , Escroto , Adulto , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/cirurgia , Humanos , Linfedema/cirurgia , Masculino , Doenças do Pênis/cirurgiaRESUMO
Although there are several reports of intracranial hemorrhage associated with vitamin K deficient bleeding, there are few reported cases of extracranial manifestations, specifically involving the thymus. Here, we discuss the unique case of a 4-week-old infant presenting with scrotal discoloration, respiratory distress, and widened mediastinum, found to have thymic hemorrhage related to confirmed coagulopathy secondary to late-onset vitamin K deficiency bleeding of the newborn.
Assuntos
Contusões/etiologia , Escroto/patologia , Timo/patologia , Deficiência de Vitamina K/complicações , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/uso terapêutico , Contusões/patologia , Diagnóstico Diferencial , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/patologia , Humanos , Recém-Nascido , Masculino , Mediastino/diagnóstico por imagem , Mediastino/patologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Escroto/irrigação sanguínea , Timo/irrigação sanguínea , Resultado do Tratamento , Vitamina K/administração & dosagem , Vitamina K/uso terapêutico , Deficiência de Vitamina K/diagnóstico , Deficiência de Vitamina K/patologia , Sangramento por Deficiência de Vitamina K/tratamento farmacológicoRESUMO
Immunoglobulin G4 related disease (IgG4-RD) is a fibro-inflammatory disease of unknown etiology, characterized by lesions in the form of tumors, elevated serum IgG4 levels, plasma cells with significant IgG4 infiltration, accompanied by phlebitis obliterans and fibrosis. This disease usually has multiorgan disease, including pancreas, biliary tract, salivary glands, peri orbital tissues, kidneys, lungs, lymph nodes and retro peritoneum. IgG4-RD mainly affects men with a predominance of age by young adults until old age. The clinical manifestations of IgG4-RD, depend mainly on the organs affected and the response to steroids. His forecast is not yet clear. Within the affected urogenital organs can be observed kidney, retroperitoneum, ureter, bladder, urachus, testis/epididymis, paratesticular region, prostate and urethra.
La enfermedad relacionada con la inmunoglobulina G4 (ER-IgG4) es una enfermedad fibroinflamatoria de etiología desconocida, la cual se caracteriza por presentar lesiones en forma de tumoraciones, concentraciones séricas aumentadas de IgG4 y células plasmáticas con una infiltración importante de IgG4, junto con flebitis obliterante y fibrosis. Esta enfermedad suele tener afección multiorgánica, incluyendo el páncreas, el tracto biliar, las glándulas salivares, los tejidos periorbitarios, los riñones, los pulmones, los ganglios linfáticos y el retroperitoneo. La ER-IgG4 afecta principalmente a hombres, con un predominio de edad por los adultos jóvenes y hasta la vejez. Las manifestaciones clínicas de la ER-IgG4 dependen principalmente de los órganos afectados y de la respuesta a los esteroides. Su pronóstico aún no es del todo claro. Dentro de los órganos urogenitales afectados pueden incluirse el riñón, el retroperitoneo, el uréter, la vejiga, el uraco, el testículo/epidídimo, la región paratesticular, la próstata y la uretra.
Assuntos
Hipergamaglobulinemia/complicações , Imunoglobulina G , Doenças Urológicas/etiologia , Corticosteroides/uso terapêutico , Adulto , Idoso , Algoritmos , Feminino , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/patologia , Granuloma de Células Plasmáticas/etiologia , Granuloma de Células Plasmáticas/patologia , Humanos , Hipergamaglobulinemia/diagnóstico , Hipergamaglobulinemia/tratamento farmacológico , Hipergamaglobulinemia/patologia , Masculino , Pessoa de Meia-Idade , Especificidade de Órgãos , Flebite/etiologia , Plasmócitos/patologia , Fibrose Retroperitoneal/etiologia , Doenças Urológicas/tratamento farmacológico , Doenças Urológicas/fisiopatologia , Adulto JovemRESUMO
Lymphedema is the result of an alteration of the lymphatic drainage, and its most common worldwide cause is filariasis. In our practice usually is associated to neoplasic, inflammatory and granulomatous processes, radiotherapy, hydroelectrolytic disbalances, and idiopathic. It can affect any part of the body, including the penis and scrotum. The genital lymphedema is a rare presentation, it corresponds to 0.6% of lymphedema. However, causes serious functional, social and emotional limitations for the patient. Too often have pain, recurrent infections, sexual dysfunction, cosmetic deformity, sometimes it limits mobility and ambulation. Although there are several treatment options, both medical and surgical, it has not been found ideal for this disease. We present a 43 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa, it limits his normal activity. The patient was referred to our center after unsuccessful medical treatment (doxycycline and clindamycin cycles). Surgical treatment consisted of total excision of the skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. The result was satisfactory both functionally and aesthetically.
El linfedema es producto de una alteración en el drenaje linfático, y su causa más frecuente en todo el mundo es la filariasis. En nuestro medio suele encontrarse asociada a procesos neoplásicos, inflamatorios, granulomatosos, secuelas por radioterapia, desequilibrios hidroelectrolíticos y procesos idiopáticos. Puede afectar a cualquier parte del cuerpo, incluyendo el pene y el escroto. El linfedema genital es una presentación infrecuente, que corresponde al 0.6% de los linfedemas. No obstante, causa graves limitaciones funcionales, sociales y emocionales para el paciente. Con mucha frecuencia se presentan dolor, infecciones recurrentes, disfunción sexual y deformidad estética, llegando incluso a limitar la movilidad y la deambulación. Aunque existen varias opciones de tratamiento, tanto médico como quirúrgico, no se ha encontrado el ideal para esta enfermedad. Presentamos el caso de un paciente de 43 años afecto de hidrosadenitis axilar e inguinal que padece linfedema penoescrotal grave que limita seriamente su actividad habitual. El paciente fue remitido a nuestro centro tras el fracaso del tratamiento con antibióticos (ciclos de doxiciclina y clindamicina). El tratamiento quirúrgico consistió en la resección de piel y tejido celular subcutáneo hasta fascia de Buck y cobertura con injertos de piel. El resultado final fue adecuado desde un punto de vista tanto funcional como estético.
Assuntos
Doenças dos Genitais Masculinos/etiologia , Hidradenite Supurativa/complicações , Linfedema/etiologia , Escroto , Adulto , Clindamicina/uso terapêutico , Fístula Cutânea/etiologia , Doxiciclina/uso terapêutico , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças dos Genitais Masculinos/tratamento farmacológico , Doenças dos Genitais Masculinos/cirurgia , Hidradenite Supurativa/tratamento farmacológico , Hidradenite Supurativa/cirurgia , Humanos , Linfedema/cirurgia , Imageamento por Ressonância Magnética , Masculino , Doenças do Pênis/diagnóstico por imagem , Doenças do Pênis/tratamento farmacológico , Doenças do Pênis/etiologia , Doenças do Pênis/cirurgia , Escroto/cirurgia , Transplante de PeleRESUMO
The purpose of this study was to assess whether the incidence of histopathologically confirmed condyloma and penile intraepithelial neoplasia (PeIN) and rates of genital HPV infection progression to these lesions differs by country (Brazil, Mexico and the U.S.). At each visit, lesions were biopsied and were categorized by pathologic diagnoses. The Linear Array genotyping method was used to identify HPV genotypes from genital swabs, while the INNO-LiPA HPV Genotyping Extra method was used for tissue specimens. Age-specific analyses were conducted for lesion incidence by country, with Kaplan-Meier estimation of cumulative incidence. The proportion of HPV infections that progressed to condyloma and PeIN, the median time to lesion development and the incidence rates were estimated by country. When comparing demographic and sexual characteristics across the three countries, sexual orientation (p = 0.008) and lifetime number of female sexual partners (p < 0.0001) were differentially associated with lesion incidence in the three countries. Condyloma incidence in Brazil and the U.S. decreased with age, while incidence remained constant across the lifespan in Mexico. There were no differences by country and age for PeIN incidence. HPV types 6 and 11 were the most common types to progress to condyloma and HPV types 16, 6 and 11 were the most common types to progress to PeIN in all three countries. The continuous risk of condyloma and PeIN across all age groups and countries in this study emphasizes the need to ensure that strong HPV immunity, such as that obtained through vaccination, is maintained across the lifespan of men.
Assuntos
Doenças dos Genitais Masculinos/epidemiologia , Doenças dos Genitais Masculinos/virologia , Infecções por Papillomavirus/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Doenças dos Genitais Masculinos/etiologia , Genótipo , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/etiologia , Infecções por Papillomavirus/virologia , Fatores de Risco , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Sexually transmitted diseases (STDs) and in particular genital ulcer disease (GUD) have a major impact on morbidity and mortality in developing countries. The World Health Organization recommends the use of syndromic guidelines for the treatment of sexually transmitted infections (STIs) in resource-constrained countries. Surveillance of autochthonous etiologies provides epidemiological information contributing to the prevention and treatment of STIs. We investigated the etiology and factors associated with GUD among male patients attending a STD clinic in Havana, Cuba. METHODS: Swabs from genital ulcers of 113 male patients, collected from May 2012 to June 2015, were analyzed using PCR for herpes simplex virus types 1 and 2, Treponema pallidum, Haemophilus ducreyi, and Chlamydia trachomatis. We also investigated the clinical and epidemiological characteristics associated with the presence of these pathogens in GUD. RESULTS: At least one of the pathogens was detected in 70% of patients. The occurrence of the pathogens was herpes simplex virus type 2 (HSV-2) (51.3%), T. pallidum (29.2%), and C. trachomatis (1.8%). Co-infections occurred as follows: T. pallidum-HSV-2 (10.6%), C. trachomatis-HSV-2 (0.9%) and C. trachomatis-T. pallidum (0.9%). Herpes simplex virus type 1 and H. ducreyi were not detected. Ages 15 to 40 years, HIV-positive serostatus, and no condom use were significant risk factors for the presence of HSV-2 in genital ulcers. CONCLUSIONS: Our preliminary results highlight the predominance of HSV-2 and T. pallidum as the leading GUD etiologies in the study population and identified risk factors associated with HSV-2. This information should help to inform guidelines for better management of GUD in Havana, Cuba.
Assuntos
Doenças dos Genitais Masculinos/etiologia , Herpesvirus Humano 2/isolamento & purificação , Infecções Sexualmente Transmissíveis/etiologia , Treponema pallidum/isolamento & purificação , Úlcera/etiologia , Adolescente , Adulto , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Coinfecção , Cuba/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Doenças dos Genitais Masculinos/virologia , Soropositividade para HIV , Haemophilus ducreyi/genética , Haemophilus ducreyi/isolamento & purificação , Herpesvirus Humano 1/genética , Herpesvirus Humano 1/isolamento & purificação , Herpesvirus Humano 2/genética , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/virologia , Treponema pallidum/genética , Úlcera/epidemiologia , Úlcera/virologia , Adulto JovemRESUMO
We performed an exploratory study by analyzing the correlation of 46, XY disorders of sex development (46, XY DSD) with androgen receptor (AR) and steroid 5α-reductase-2 (SRD5A2) gene mutations and a safety analysis of dihydrotestosterone (DHT) gel treatment for pediatric micropenis. We collected samples from 76 pediatric patients with 46, XY DSD and 50 healthy adult men with normal fertility as the control group. The pediatric patients were treated with DHT gel (0.1-0.3 mg/kg/day) for three to six months. The extended penis length, testicular volume, and multiple blood parameters were collected before treatment and one, three, and six months after treatment. Of the 76 cases with 46, XY DSD, 31.58% had hypospadias with micropenis and 6.58% had male pseudohermaphroditism. Through AR gene screening, it was found that 14 patients had AR point mutations and 22 patients had SRD5A2 mutations. After treatment with DHT, the penis length of the patients significantly improved after one, three, and six months of treatment, with longer treatment times resulting in greater improvement. Before treatment with DHT, the average serum DHT value of patients with 46, XY DSD was 24.29 pg/mL. After one, three, and six months of treatment, this value increased to 430.71, 328.9, and 323.6 pg/mL, respectively. We conclude that for pediatric patients who have male hermaphroditism or hypospadias with micropenis, AR and SRD5A2 gene mutation detection should be performed. Local application of DHT gel can promote penis growth effectively without systemic adverse reactions.
Assuntos
3-Oxo-5-alfa-Esteroide 4-Desidrogenase/genética , Transtorno 46,XY do Desenvolvimento Sexual/metabolismo , Hipospadia/metabolismo , Proteínas de Membrana/genética , Mutação , Receptores Androgênicos/genética , Adulto , Criança , China , Di-Hidrotestosterona/sangue , Di-Hidrotestosterona/uso terapêutico , Transtorno 46,XY do Desenvolvimento Sexual/complicações , Transtorno 46,XY do Desenvolvimento Sexual/genética , Testes Genéticos , Doenças dos Genitais Masculinos/sangue , Doenças dos Genitais Masculinos/tratamento farmacológico , Doenças dos Genitais Masculinos/etiologia , Humanos , Hipospadia/etiologia , Hipospadia/genética , Masculino , Pênis/anormalidadesAssuntos
Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças dos Genitais Masculinos/etiologia , Diálise Peritoneal/efeitos adversos , Doenças Peritoneais/diagnóstico por imagem , Doenças Peritoneais/etiologia , Escroto/diagnóstico por imagem , Idoso , Soluções para Diálise , Humanos , Masculino , Compostos de Organotecnécio , Peritônio/diagnóstico por imagem , Ácido Fítico , Cintilografia , Compostos RadiofarmacêuticosRESUMO
BACKGROUND: The aim of this study is to compare two different preparations in patients undergoing transrectal prostate biopsies samples (TPBS) and assess the prevalence of genitourinary infections (GUI). METHODS: A historical cohort of patients undergoing TBPS for suspected prostate cancer. Two groups were compared: one with endorectal lubricant jelly and another with the addition of a povidone-iodine lubricating jelly. Complications were evaluated at three weeks. A bivariate analysis was performed by calculating the OR (95 % CI) to determine if the additional endorectal povidone-iodine pre-TBPS reduced GUI and other complications. RESULTS: 185 patients (Group I n = 86, Group II n = 96) were evaluated. 45 and 25 % had genitourinary tract infection (OR: 0.4, CI: 0.2-0.9, p = 0.004); fever was presented in 21 and 10 % respectively (OR: 0.42, CI: 0.1-0.9, p = 0.04). CONCLUSIONS: A reduction was observed in the presence of genitourinary infections in patients who had intrarectal povidone-iodine preparation applied.
Introducción: el objetivo de este estudio es comparar dos preparaciones distintas en pacientes sometidos a la toma de biopsias prostáticas transrectales (BPTR) y evaluar la prevalencia de infecciones genitourinarias (IGU). Métodos: se compararon dos grupos de pacientes con sospecha de cáncer de próstata sometidos a Biopsia Prostática Transrectal (BPTR): Con jalea lubricante endorrectal (grupo l, cohorte histórica) y con jalea lubricante más iodopovidona (grupo II, cohorte prospectiva). Se evaluaron las complicaciones a las tres semanas. Se realizó un análisis bivariado, calculando su OR (IC: 95 %) para determinar si la iodopovidona endorrectal adicional previa a la BPTR disminuye las IGU y otras complicaciones. Resultados: Se evaluaron 185 pacientes (Grupo I n = 86; grupo II n = 96). Tuvieron infección del tracto genitourinario el 45 y 25 % (OR: 0.4, IC: 0.2-0.9, p = 0.004); la fiebre se presentó en el 21 y 10 % respectivamente (OR: 0.42, IC: 0.1-0.9, p = 0.04). Conclusiones: Se observó una reducción en la presencia de infecciones genitourinarias en pacientes a quienes se aplicó en su preparación iodopovidona intrarrectal.