RESUMEN
OBJECTIVE: To estimate the burden of genital warts (GW)in Mexico. MATERIALS AND METHODS: We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. RESULTS: The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. CONCLUSIONS: This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.
OBJETIVO: Estimar la carga por verrugas genitales (VG) en México. MATERIAL Y MÉTODOS: Estimamos la incidencia anual de VG, con base en información proporcionada por médicos especialistas y el manejo de las VG, así como el costo promedio del tratamiento y la carga psicosocial de las VG. RESULTADOS: La incidencia anual de VG en México fue de 547 200 casos. Los tratamientos variaron según la especialidad y el sexo del paciente. El costo anual por VG fue de $195 millones de dólares estadounidenses. El impacto psicosocial de las VG es ligeramente mayor en hombres que en mujeres. CONCLUSIONES: Esta es la primera evaluación de la carga de VG en México. Los datos sugieren que las VG son frecuentes, tienen costos relacionados con salud e impactos psicosociales significativos.
Asunto(s)
Enfermedades del Ano/epidemiología , Condiloma Acuminado/epidemiología , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Masculinos/epidemiología , Adulto , Enfermedades del Ano/economía , Enfermedades del Ano/psicología , Enfermedades del Ano/terapia , Terapia Combinada , Condiloma Acuminado/economía , Condiloma Acuminado/psicología , Condiloma Acuminado/terapia , Costo de Enfermedad , Femenino , Enfermedades de los Genitales Femeninos/economía , Enfermedades de los Genitales Femeninos/psicología , Enfermedades de los Genitales Femeninos/terapia , Enfermedades de los Genitales Masculinos/economía , Enfermedades de los Genitales Masculinos/psicología , Enfermedades de los Genitales Masculinos/terapia , Costos de la Atención en Salud , Encuestas Epidemiológicas , Humanos , Incidencia , Masculino , Medicina/estadística & datos numéricos , México/epidemiología , Persona de Mediana Edad , Papillomaviridae/aislamiento & purificación , Vacunas contra Papillomavirus , Prevalencia , Calidad de VidaRESUMEN
La infección por el Virus del Papiloma Humano es una afección altamente prevalente a nivel mundial y una de sus consecuencias es la verruga genital externa o condiloma genital. El tratamiento de estas lesiones ha sido tradicionalmente difícil, debido a la alta recurrencia de las lesiones. Se revisan los aspectos más novedosos del tratamiento de las verrugas genitales. Las sinecatequinas y una nueva formulación de Imiquimod al 3,75% resaltan como las terapéuticas más novedosas, mientras que la terapia fotodinámica carece de evidencia científica adecuada como para recomendar su uso rutinario. Las vacunas profilácticas y terapéuticas parecen poseer un gran potencial pero aún se encuentran en fases iniciales de investigación. Es deseable estudios con un mayor número de pacientes y un seguimiento más prolongado, que permita una comparación directa de la efectividad entre las diferentes técnicas terapéuticas a corto y largo plazo.
Human Papillomavirus infection is a highly prevalent condition worldwide whose frequent consequence is the external genital wart or genital condyloma. The treatment for this condition has been traditionally difficult due to the recurrence of the lesions. The most innovative aspects of the treatment of genital wart, are reviewed. The sinecatechins and a new formulation of Imiquimod 3.75% stand out as the most innovative therapeutic, while photodynamic therapy lacks adequate scientific evidence to recommend its routine use. The prophylactic and therapeutic vaccines seem to have great potential but are still in early stages of research. Studies should be conducted with larger patient samples and longer follow-ups to allow comparison of the effectiveness among the different therapeutic techniques in the short and long term.
Asunto(s)
Humanos , Masculino , Femenino , Condiloma Acuminado/terapia , Alphapapillomavirus , Enfermedades de los Genitales Femeninos/terapia , Fotoquimioterapia , Podofilino , Ácido Tricloroacético , Condiloma Acuminado/diagnóstico , Catequina/uso terapéutico , Vacunación , Crioterapia , Infecciones por Papillomavirus/terapia , Electrocoagulación , Imiquimod/uso terapéutico , Enfermedades de los Genitales Masculinos/terapiaRESUMEN
BACKGROUND: Genital warts are caused by human papillomavirus infection and represent one of the most common sexually transmitted diseases. Many infections are transient but the virus may recur, persist, or become latent. To date, there is no effective antiviral treatment to eliminate HPV infection and most therapies are aimed at the destruction of visible lesions. Potassium hydroxide is a strong alkali that has been shown to be safe and effective for the treatment of genital warts and molluscum contagiosum. Cryotherapy is considered one of the most established treatments for genital warts. No comparative trials have been reported to date on the use of potassium hydroxide for genital warts. OBJECTIVE: A prospective, open-label, randomized clinical trial was conducted to compare topical potassium hydroxide versus cryotherapy in the treatment of genital warts affecting immunocompetent, sexually active men. METHODS: Over a period of 10 months, 48 patients were enrolled. They were randomly divided into two groups and selected on an alternative basis for either potassium hydroxide therapy or cryotherapy. While response to therapy did not differ substantially between both treatment modalities, side effects such as local pain and post-treatment hypopigmentation were considerably more prevalent in the groups treated using cryotherapy. RESULT: In our study, potassium hydroxide therapy proved to be at least as effective as cryotherapy and offered the benefit of a better safety profile. CONCLUSION: Topical 5% potassium hydroxide presents an effective, safe, and low-cost treatment modality for genital warts in men and should be included in the spectrum of therapies for genital warts.
Asunto(s)
Condiloma Acuminado/terapia , Crioterapia/métodos , Fármacos Dermatológicos/administración & dosificación , Enfermedades de los Genitales Masculinos/terapia , Hidróxidos/administración & dosificación , Compuestos de Potasio/administración & dosificación , Administración Tópica , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Fármacos Dermatológicos/uso terapéutico , Relación Dosis-Respuesta a Droga , Estudios de Seguimiento , Humanos , Hidróxidos/uso terapéutico , Masculino , Persona de Mediana Edad , Compuestos de Potasio/uso terapéutico , Estudios Prospectivos , Reproducibilidad de los Resultados , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Genital warts are caused by human papillomavirus infection and represent one of the most common sexually transmitted diseases. Many infections are transient but the virus may recur, persist, or become latent. To date, there is no effective antiviral treatment to eliminate HPV infection and most therapies are aimed at the destruction of visible lesions. Potassium hydroxide is a strong alkali that has been shown to be safe and effective for the treatment of genital warts and molluscum contagiosum. Cryotherapy is considered one of the most established treatments for genital warts. No comparative trials have been reported to date on the use of potassium hydroxide for genital warts. OBJECTIVE: A prospective, open-label, randomized clinical trial was conducted to compare topical potassium hydroxide versus cryotherapy in the treatment of genital warts affecting immunocompetent, sexually active men. METHODS: Over a period of 10 months, 48 patients were enrolled. They were randomly divided into two groups and selected on an alternative basis for either potassium hydroxide therapy or cryotherapy. While response to therapy did not differ substantially between both treatment modalities, side effects such as local pain and post-treatment hypopigmentation were considerably more prevalent in the groups treated using cryotherapy. Result: In our study, potassium hydroxide therapy proved to be at least as effective as cryotherapy and offered the benefit of a better safety profile. CONCLUSION: Topical 5% potassium hydroxide presents an effective, safe, and low-cost treatment modality for genital warts in men and should be included in the spectrum of therapies for genital warts. .
Asunto(s)
Adolescente , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Condiloma Acuminado/terapia , Crioterapia/métodos , Fármacos Dermatológicos/administración & dosificación , Enfermedades de los Genitales Masculinos/terapia , Hidróxidos/administración & dosificación , Compuestos de Potasio/administración & dosificación , Administración Tópica , Distribución de Chi-Cuadrado , Relación Dosis-Respuesta a Droga , Fármacos Dermatológicos/uso terapéutico , Estudios de Seguimiento , Hidróxidos/uso terapéutico , Estudios Prospectivos , Compuestos de Potasio/uso terapéutico , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
BACKGROUND: The lack of information on the care for sexually transmitted infections (STI) associated syndromes may contribute for its non-inclusion as prevention and control strategy for STI in Brazil. This study aims to analyze the cases of STI - Associated Syndromes assisted in primary health care center in a city in Northeast Brazil associating them with socio-demographic and behavioral variables. METHODS: This is a retrospective study that analyzed 5148 consultation forms and medical records of patients assisted in a primary health care center who presented at least one genital syndrome from 1999 to 2008. Was considered as dependent variables the genital syndromes and serologies for syphilis and HIV and as independent variables the socio-demographic and behavioral aspects. It was used Pearson's chi-square test to analyze the differences between the categorical variables, with a significance level of 5%. It was performed a multivariate analysis through the multivariate logistic regression model with the variables with p <0.05. We used odds ratio with a confidence interval of 95%. RESULTS: The most frequent syndromes were vaginal discharge and/or cervicitis (44%) and genital wart (42.2%). Most people were between 20 and 39 years old (70%) and women (74.2%). Genital ulcer was most prevalent among men (OR = 2.67; CI 95% 1.99-3.58) and people who studied more than eight years (OR = 1.33; CI 95% 1.00-1.75) and wart prevailed among men (OR = 3.92; IC 95% 3.36-4.57), people under 29 years old (OR = 1.81; CI 95% 1.59-2.07) and who studied more than eight years (OR = 1.75; CI 95% 1.54-1.99). The Venereal Disease Research Laboratory (VDRL) was positive in 7.3% of men and in 7.1% of women and the Anti-HIV in 3.1% of men and 0.7% of women. CONCLUSION: Vaginal discharge was the most frequent syndrome assisted in primary health care, followed by genital wart. The high prevalence of genital wart justifies the greater effort for the proper follow-up of these cases. Men presented more genital wart and ulcer and reported having more sexual partners, showing their need for a greater access and inclusion in health activities developed in primary health care in Brazil.
Asunto(s)
Condiloma Acuminado/terapia , Enfermedades de los Genitales Masculinos/terapia , Atención Primaria de Salud/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Úlcera/terapia , Excreción Vaginal/terapia , Adolescente , Adulto , Brasil/epidemiología , Condiloma Acuminado/epidemiología , Femenino , Enfermedades de los Genitales Masculinos/epidemiología , Humanos , Masculino , Registros Médicos , Estudios Retrospectivos , Úlcera/epidemiología , Excreción Vaginal/epidemiología , Adulto JovenRESUMEN
Subcutaneous phaeohyphomycosis is a disease caused by dematiaceous fungi that develops mainly in immunocompromised patients. Lesions are generally located on the lower limbs. The present report describes a case of phaeohyphomycosis in an immunocompetent patient in whom a subcutaneous abscess was located in an unusual site, on the left hemiscrotum. The abscess was treated successfully with oral fluconazole associated with surgical excision.
Asunto(s)
Dermatomicosis/microbiología , Exophiala/aislamiento & purificación , Enfermedades de los Genitales Masculinos/microbiología , Escroto/microbiología , Antifúngicos/uso terapéutico , Dermatomicosis/diagnóstico , Dermatomicosis/terapia , Fluconazol/uso terapéutico , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/terapia , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A feo-hifomicose subcutânea é uma doença causada por fungos demáceos que acomete principalmente indivíduos imunocomprometidos e geralmente cursa com lesões localizadas nos membros inferiores. Os autores relatam um caso de feo-hifomicose subcutânea em um paciente imunocompetente, com localização atípica - na hemibolsa escrotal esquerda -, tratado com sucesso com fluconazol sistêmico associado à excisão cirúrgica.
Subcutaneous phaeohyphomycosis is a disease caused by dematiaceous fungi that develops mainly in immunocompromised patients. Lesions are generally located on the lower limbs. The present report describes a case of phaeohyphomycosis in an immunocompetent patient in whom a subcutaneous abscess was located in an unusual site, on the left hemiscrotum. The abscess was treated successfully with oral fluconazole associated with surgical excision.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Dermatomicosis/microbiología , Exophiala/aislamiento & purificación , Enfermedades de los Genitales Masculinos/microbiología , Escroto/microbiología , Antifúngicos/uso terapéutico , Dermatomicosis/diagnóstico , Dermatomicosis/terapia , Fluconazol/uso terapéutico , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/terapiaRESUMEN
Cowper's syringocele is a rare but an under-diagnosed cystic dilation of the Cowper's ducts and is increasingly being recognized in the adult population. Recent literature suggests that syringoceles be classified based on the configuration of the duct's orifice to the urethra, either open or closed, as this also allows the clinical presentations of 2 syringoceles to be divided, albeit with some overlap. Usually post-void dribbling, hematuria, or urethral discharge indicates open syringocele, while obstructive symptoms are associated with closed syringoceles. As these symptoms are shared by many serious conditions, a working differential diagnosis is critical. Ultrasonography coupled with retro and ante grade urethrography usually suffices to diagnose syringocele, but supplementary procedures - such as cystourethroscopy, computed tomography scan, and magnetic resonance imaging - can prove useful. Conservative observation is first recommended, but persistent symptoms are usually treated with endoscopic marsupialization unless contraindicated. Upon reviewing the literature, this paper addresses the clinical anatomy, classification, presentation, diagnosis, and treatment of syringoceles in further detail.
Asunto(s)
Glándulas Bulbouretrales , Quistes/diagnóstico , Enfermedades de los Genitales Masculinos/diagnóstico , Adulto , Niño , Quistes/terapia , Dilatación Patológica/clasificación , Dilatación Patológica/diagnóstico , Dilatación Patológica/terapia , Enfermedades de los Genitales Masculinos/terapia , Humanos , MasculinoRESUMEN
Cowper's syringocele is a rare but an under-diagnosed cystic dilation of the Cowper's ducts and is increasingly being recognized in the adult population. Recent literature suggests that syringoceles be classified based on the configuration of the duct's orifice to the urethra, either open or closed, as this also allows the clinical presentations of 2 syringoceles to be divided, albeit with some overlap. Usually post-void dribbling, hematuria, or urethral discharge indicate open syringocele, while obstructive symptoms are associated with closed syringoceles. As these symptoms are shared by many serious conditions, a working differential diagnosis is critical. Ultrasonography coupled with retro and ante grade urethrography usually suffices to diagnose syringocele, but supplementary procedures - such as cystourethroscopy, computed tomography scan, and magnetic resonance imaging - can prove useful. Conservative observation is first recommended, but persistent symptoms are usually treated with endoscopic marsupialization unless contraindicated. Upon reviewing the literature, this paper addresses the clinical anatomy, classification, presentation, diagnosis, and treatment of syringoceles in further detail.
Asunto(s)
Adulto , Niño , Humanos , Masculino , Glándulas Bulbouretrales , Quistes/diagnóstico , Enfermedades de los Genitales Masculinos/diagnóstico , Quistes/terapia , Dilatación Patológica/clasificación , Dilatación Patológica/diagnóstico , Dilatación Patológica/terapia , Enfermedades de los Genitales Masculinos/terapiaRESUMEN
Las urgencias en pediatría siempre han constituido un problema frecuente y, muchas veces, difícil de resolver, ya sea por la poca historia aportada por los padres -lo que es propio de la preocupación y ansiedad de la situación-, como también por la falta de información en relación a algunas maniobras simples que pueden ser realizadas por cualquier médico. Las lesiones genitourinarias suelen desestimarse en una evaluación de urgencia, a pesar de la trascendencia que éstas pudieran tener a futuro, por lo que suelen pesquisarse en una evaluación secundaria, o luego de la aparición de complicaciones. El presente artículo tiene como objetivo dar a conocer los conceptos que componen el manejo de urgencias genitourinarias en cirugía pediátrica, haciendo énfasis en aquellas que ocurren con mayor frecuencia y que implican un riesgo de complicaciones deletéreas, así como también en las que, por simplicidad de maniobras, pueden ser realizadas en cualquier servicio de atención de urgencia. Los temas expuestos son: torsión testicular, torsión de hidátide testicular, parafimosis, lesiones del tracto urinario y atrapamiento de prepucio en cremallera del pantalón.
Asunto(s)
Humanos , Masculino , Niño , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/terapia , Varicocele/diagnóstico , Varicocele/terapia , Urgencias Médicas , Parafimosis/terapia , Pediatría/métodos , Pene/lesiones , Testículo/lesiones , Torsión del Cordón Espermático/diagnóstico , Torsión del Cordón Espermático/terapia , Sistema Urinario/lesionesRESUMEN
La infección genital por virus papiloma humano constituye la infección de transmisión sexual más frecuente en la actualidad. Las verrugas genitales externas se presentan en cuatro formas clínicas diferentes: condilomas acuminados, verrugas queratóticas, verrugas papulares y verrugas planas. Las diversas alternativas terapéuticas para verrugas genitales externas se pueden clasificar en dos grandes grupos: aquellas autoaplicadas por el paciente y las aplicadas por el médico. Entre las alternativas autoaplicadas destacan Imiquimod, con tasas de curación entre 37 por ciento y 85 por ciento y recurrencias entre 5 por ciento y 19 por ciento, y la Podofilotoxina, con tasas de curación entre 45 por ciento y 88 por ciento y recurrencias entre 0 por ciento y 91 por ciento. Entre las alternativas aplicadas por el médico, tenemos métodos químicos y métodos de remoción. Entre los métodos químicos destaca Podofilina, con tasas de curación entre 19 por ciento y 80 por ciento y recurrencia entre 23 por ciento y 70 por ciento; entre los métodos de remoción destaca la crioterapia, con tasas de curación entre 60 por ciento y 97 por ciento y recurrencias de 80 por ciento.
The human papilloma virus genital infection constitutes the most frequent sexual transmission infection of our time. The clinical manifestations of external genital warts vary in four different types: acuminated condyloma, keratolic warts, papular warts and flat genital warts. The diverse therapeutic alternatives for external genitals warts can be classified in two large groups: those applied by the patient, and those applied by the physician. Among the alternatives applied by the patient, both Imiquimod, with clearance rates between 37 percent - 85 percent and recurrence between 5 percent - 19 percent; and Podofillotoxin 0.5 percent solution, with clearance rates between 45 percent - 88 percent, and recurrence between 0 percent-91 percent stand out. Among the alternatives applied by physicians, we have chemical methods and removal methods. In chemical methods Podofillin stands out with clearance rates between 19 percent - 80 percent and recurrence between 23 percent - 70 percent; among removal methods, cryotherapy is the most important, with clearance rates between 60 percent - 97 percent, and recurrence of 80 percent.
Asunto(s)
Humanos , Masculino , Femenino , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/terapia , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/terapia , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/terapia , Condiloma Acuminado/clasificación , Diagnóstico DiferencialRESUMEN
BACKGROUND: Necrotizing gangrene of the genitalia and perineum is a fulminant, life-threatening condition. This infection is usually polymicrobial and may be idiopathic or secondary to local trauma or surgery. Histologically, it is characterized by obliterative endarteritis and thrombosis of the subcutaneous vessels, fascial necrosis, and leukocytic infiltration. Mortality rates of 25-75% have been reported. Most cases of necrotizing gangrene begin insidiously, with scrotal discomfort and malaise. Later, erythema, increasing pain, and swelling, associated with fever and chills, develop. A biopsy is useful to confirm the clinical diagnosis and to obtain culture samples. Ultrasound imaging may reveal gas or testicular involvement and may help to distinguish this infection from other causes of scrotal pathology. MATERIALS AND METHODS: Fifteen patients with necrotizing gangrene of the genitalia and perineum, seen at the Dermatology and Plastic Surgery Sections of our Institutions between 1994 and 1999, are described. RESULTS: This series included 11 men (73%) and four women (27%), aged 39-68 years (mean, 51 years). In our series, Clostridium perfingens, Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, Streptococcus viridans, Acinetobacter baumani, Escherichia coli, and Candida albicans were isolated. Hemodynamic stabilization and monitoring were performed in all patients. Intravenous antimicrobial therapy was promptly instituted. In most cases, two or more drugs were used. Concurrent surgical debridement of all necrotic areas was always required. When needed, split-thickness skin grafts were used to cover the penile shaft. Expanded mesh grafts were used to reconstruct the vulva and other denuded beds. The survival rate in this series was 87%. CONCLUSIONS: Necrotizing gangrene of the genitalia and perineum continues to be a diagnostic and therapeutic challenge. The usual polymicrobial infection with vascular involvement demands hemodynamic stabilization, systemic antimicrobial therapy, and surgical debridement. In some patients, genital, perineal, and abdominal wall reconstruction is also required.
Asunto(s)
Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/terapia , Gangrena/diagnóstico , Gangrena/terapia , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/terapia , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/terapia , Perineo/patología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perineo/diagnóstico por imagen , Perineo/microbiología , UltrasonografíaRESUMEN
BACKGROUND: Clinical diagnosis of genital ulcers is difficult, and diagnostic tests are least available in settings where rates of disease are highest. The World Health Organization (WHO) has developed protocols for the syndromic management of genital ulcers in resource-poor settings. However, because risk factors, patterns and causes of disease, and antimicrobial susceptibilities differ from region to region and over time, they must be adapted to local situations. GOAL: The goal of this study was to determine etiologic factors, evaluate syndromic management, and compare polymerase chain reaction (PCR) testing with other diagnostic alternatives for genital ulcers among patients attending sexually transmitted disease clinics in the Dominican Republic and Peru. STUDY DESIGN: Eighty-one men with genital ulcers in the Dominican Republic and 63 in Peru underwent identical interviews and identical multiplex PCR (M-PCR) tests of genital lesion specimens for etiologic diagnoses. Algorithms for managing genital ulcers were developed. RESULTS: In the Dominican Republic, 5% were M-PCR-positive for, 26% for, and 43% for herpes simplex virus (HSV); in Peru, 10%, 5%, and 43%, respectively, were positive. The WHO algorithm for treating syphilis and chancroid had a sensitivity of 100%, a positive predictive value (PPV) of 24%, and an overtreatment rate of 76%. A modified algorithm for treating only those without vesicular lesions had 88% sensitivity and a 27% PPV, and the overtreatment rate was reduced to 58%. CONCLUSION: HSV caused 43% of genital ulcers in these populations. The modified algorithm had lower sensitivity but a reduced overtreatment rate. M-PCR testing was more sensitive than standard tests and more specific and sensitive than clinical diagnosis.
Asunto(s)
Chancroide/complicaciones , Enfermedades de los Genitales Masculinos/etiología , Enfermedades de los Genitales Masculinos/terapia , Herpes Genital/complicaciones , Sífilis/complicaciones , Úlcera/etiología , Úlcera/terapia , Adolescente , Adulto , Antibacterianos/uso terapéutico , Chancroide/diagnóstico , Chancroide/epidemiología , ADN Bacteriano/análisis , ADN Viral/análisis , República Dominicana/epidemiología , Enfermedades de los Genitales Masculinos/epidemiología , Herpes Genital/diagnóstico , Herpes Genital/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Reacción en Cadena de la Polimerasa , Prevalencia , Sensibilidad y Especificidad , Sífilis/diagnóstico , Sífilis/epidemiología , Úlcera/epidemiologíaRESUMEN
We report our experience and results in the management of Fournier's gangrene. Fournier's gangrene is a synergistic infective necrotizing fasciitis, which involves perianal, perineal and genital regions, originated mostly from colorectal and genitourinary sources. Charts and records from 28 patients with Fournier's gangrene diagnosed between 1993 and 1997 were reviewed. The mean patients age was 57.8 years (range, 22-82 years); mean hospital stay was 19 days. Eighteen patients (64.3%) were diabetic. The most common source of gangrene was ischiorectal abscess in 22 patients (78.6%). Colostomy was performed on 14 patients (50%) and cystostomy on 7 patients (25%). Ten patients (35.7%) died because of sepsis. In conclusion, medical and surgical treatment should be aggressive. Colostomy should only be performed if sphincter complex is damaged. Multidisciplinary management is mandatory, because of high morbidity and mortality.
Asunto(s)
Gangrena de Fournier/terapia , Enfermedades de los Genitales Masculinos/terapia , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Colostomía , Terapia Combinada , Quimioterapia Combinada , Gangrena de Fournier/microbiología , Gangrena de Fournier/cirugía , Enfermedades de los Genitales Masculinos/microbiología , Enfermedades de los Genitales Masculinos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Sexually transmitted diseases are a persistent problem in the United States and throughout the world. Many of these infections involve the skin and may be encountered in the field of dermatology. This 3-part review highlights the cutaneous features, diagnosis, and treatment of 11 of the most common sexually transmitted diseases, other than AIDS. The second part of this series focuses on anogenital warts, chronic viral hepatitis, molluscum contagiosum, scabies, and pediculosis pubis. Additional features, such as epidemiology and transmission of the organism, are discussed when applicable. (J Am Acad Dermatol 1999;41:661-77.) LEARNING OBJECTIVE: At the conclusion of this learning activity, participants should be familiar with the clinical features, diagnosis, and treatment of sexually transmitted diseases (excluding AIDS) which have cutaneous presentations or involvement.
Asunto(s)
Femenino , Masculino , Humanos , Condiloma Acuminado , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/terapia , Enfermedades del Ano/diagnóstico , Enfermedades del Ano/terapia , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/terapia , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/terapia , Escabiosis/diagnóstico , Escabiosis/terapia , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/terapia , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/terapia , Infestaciones por Piojos/diagnóstico , Infestaciones por Piojos/terapia , Molusco Contagioso/diagnóstico , Molusco Contagioso/terapiaRESUMEN
OBJECTIVES: Fournier's gangrene (FG) is an extensive fulminant infection of the genitals, perineum, or the abdominal wall. We report our experience with the management of this difficult infectious disease. METHODS: Thirty-eight patients were admitted with the diagnosis of FG between May 1993 and May 1995. All patients were treated with broad-spectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning, and application of unprocessed honey dressings. Patients then underwent split-thickness skin grafts or delayed closure as needed. RESULTS: Patient ages ranged between 33 and 86 years (mean, 54) with a mean hospital stay of 17 days (range, 1 to 45). Sixty-six percent of the patients were diabetic, 16% had previous orchiepididymitis, and 5% had scrotal and urethral trauma. All the patients underwent surgical debridement and application of unprocessed honey to the wound. Cystostomy was performed in 60% of the patients and 21% underwent orchiectomy of the affected side. Free skin grafts were applied to 6 patients (16%) and the remaining wounds, once clean, were approximated. One patient died as a result of severe metabolic acidosis and sepsis. CONCLUSIONS: The management of this infectious entity should be aggressive. Patients with FG need extensive debridement and cystostomy or colostomy when necessary. Broad-spectrum triple antimicrobial regimen and aggressive debridement are mandatory. Topical application of unprocessed honey is beneficial to the healing process. A minority of patients require split-thickness skin grafts on denuded areas.
Asunto(s)
Gangrena de Fournier/terapia , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de los Genitales Masculinos/terapia , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Diagnóstico Diferencial , Enfermedades Autoinmunes/etiología , Enfermedades de los Genitales Femeninos/patología , Enfermedades de los Genitales Femeninos/terapia , Enfermedades de los Genitales Masculinos/patología , Enfermedades de los Genitales Masculinos/terapia , Esclerodermia Localizada/diagnóstico , Historia del Siglo XIX , Historia del Siglo XX , Liquen Escleroso y Atrófico/clasificación , Liquen Escleroso y Atrófico/dietoterapia , Liquen Escleroso y Atrófico/etiología , Liquen Escleroso y Atrófico/historia , Liquen Escleroso y Atrófico/terapiaRESUMEN
Foram analisados, retrospectivamente, os prontuários de 48 pacientes com síndrome de Forunier atendidos no Serviço de Cirurgia de Emergência do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, no período de 1982 a 1991. Foram analisados os dados clínicos e laboratoriais à admissäo. Os seguintes fatores, associados a um mau prognóstico, foram considerados estatísticamente significativos: elevaçäo da creatinina sérica, hipoxemia, alcalose ou acidose metabólica, diabete e idade maior que 50 anos. Baseados nestes critérios, os pacientes foram divididos em dois grupos: grupo I, forma leve (32 casos) e grupo II, forma grave (16 casos). Acreditamos que esta classficaçäo permita um melhor planejamento da terapêutica. Nos casos classificados como graves, o tratamento deve incluir debridamento amplo, com ressecçäo de todos os tecidos necróticos, reoperaçöes programadas, transversocolostomia, antibioticoterapia de amplo espectro e nutriçäo parenteral total. Nas formas leves, os pacients podem ser tratados com debridamento e antibioticoterapia
Asunto(s)
Humanos , Masculino , Adolescente , Adulto , Persona de Mediana Edad , Escroto , Gangrena/terapia , Estudios Retrospectivos , Gangrena/etiología , Gangrena/patología , Enfermedades de los Genitales Masculinos/patología , Enfermedades de los Genitales Masculinos/terapia , SíndromeRESUMEN
The records of 48 patients with Fournier's syndrome (FS) treated at the Emergency Surgical Service of the Hospital das Clínicas of the University of São Paulo Medical School in the period 1982-1991 were reviewed. Clinical and laboratory data at admission were analysed. The following factors were statistically significant when associated with bad prognosis: elevated serum creatinine, hypoxemia, metabolic alkalosis or acidosis, diabetes and age over 50 years. Based on these five criteria, the patients were divided into two groups: Group I, mild FS (32 cases) and Group II, severe FS (16 patients). This classification permits a better planning of therapy. In cases classified as severe, treatment should include wide débridement, with resection of all necrotic tissues, scheduled reoperations for further débridements, transverse colostomy, wide spectrum antibiotic therapy and total parenteral nutrition. In the mild cases, the patients may be treated with débridement and antibiotics only.