Pathological Antecedents Research Articles

Pregnancy in adolescence and adverse neonatal outcomes in Ecuadorian mestizo newborns

To establish the association between pregnancy in early and middle adolescence and adverse neonatal outcomes in Ecuadorian mestizo newborns. Study design: epidemiological, observational/descriptive, and cross-sectional. Gynecological and Obstetric Hospital Isidro Ayora at Quito, Ecuador, from July to October of 2018. this study included 303 newborns and their mothers, 101 children of adolescent mothers between 14 and 16 years old, 101 adolescents between the ages of 17 and 19, and 101 infants born to adult mothers between 20 and 34 years of age. There is no statistically significant association between maternal age, gestation time, neonatal morbidity and APGAR at 5min. Neonatal morbidity is higher in adolescent mothers residing in rural areas and in these who had fewer than five prenatal check-ups. In the case of mothers with a pathological history, regardless of the area in which they resided, the highest percentages were recorded in the case of mothers of 24-30 years with five or more prenatal appointments, and in adolescent mothers from 14 to 19 years of age with fewer than five prenatal appointments. Indeed, the greater the number of prenatal evaluations the higher the percentage of pathological findings. There is a close relationship between the age of the mother and the number of prenatal check-ups performed during pregnancy. Teenage mothers have a higher percentage of neonatal morbidity in deliveries with gestational age equal to or greater than 37 weeks of gestation and AGPAR 8 and 9at 5min. In addition, there were a higher percentage of cases of respiratory failure and sepsis in newborns, especially when fewer than five prenatal examinations were performed. The highest percentage of identified prenatal pathological antecedents occurred in the group of mothers from 20 to 34 years old who attended more than five prenatal controls. Young pregnant women go less frequently to prenatal appointments, particularly in rural areas, and their newborns have a higher percentage of respiratory failure and sepsis.

Adherence to the Mediterranean Diet and Bone Fracture Risk in Middle-Aged Women: A Case Control Study.

The prevention of bone mass loss and related complications associated with osteoporosis is a significant public health issue. The Mediterranean diet (MD) is favorably associated with bone health, a potentially modifiable risk factor. The objective of this research was to determine MD adherence in a sample of women with and without osteoporosis. In this observational case-control study of 139 women (64 women with and 75 without osteoporosis) conducted in a primary-care health center in Girona (Spain), MD adherence, lifestyle, physical exercise, tobacco and alcohol consumption, pathological antecedents, and FRAX index scores were analyzed. Logistic multilinear regression modeling to explore the relationship between the MD and bone fracture risk indicated that better MD adherence was associated with a lower bone risk fracture. Non-pharmacological preventive strategies to reduce bone fracture risk were also reviewed to explore the role of lifestyle and diet in bone mass maintenance and bone fracture prevention.

Síndrome de Parry-Romberg asociado a infarto cerebral con epilepsia refractaria: reporte de un caso

La hemiatrofia facial progresiva o síndrome de Parry-Romberg es una alteración facial adquirida, típicamente unilateral sin una etiología conocida. Se presenta paciente femenina, raza blanca de 30 años de edad con antecedentes patológicos de hemiatrofia facial progresiva o síndrome de Parry-Romberg, que comienza con hemiparesia izquierda (brazo y cara), pérdida de conciencia, desviación de la mirada hacia la derecha y desorientación. Se realiza TAC de cráneo simple donde se constata infarto cerebral. Al día siguiente comienza con convulsiones tónico-clónico generalizadas y se discute como epilepsia refractaria.

Sporadic Creutzfeldt Jakob disease with fast progressive evolution – A challenging diagnosis – A case report

Creutzfeldt-Jakob disease (CJD), a spongiform encephalopathy, is a rare and fatal condition that affects the brain. It causes brain damage that worsens rapidly over time. We herein report the case of a 67 years old patient without pathological antecedents who was admitted to our department for visual and gait disturbances, coreo-athetotic movements and confusional state, symptomatology that had started about one month before and worsened progressively. The neurological exam pointed out: cortical blindness, coreoathetotic movements left more than right, hyperestesia. Laboratory test results revealed hyperglycemia. All others tests (B12 vitamin, B,C, hepatitis, HIV, FT4, TSH hormones, paraneoplastic and autoimmune markers – NMDA, GABA, VKGT) were physiologically within limits. The cerebrospinal fluid analysis revealed an intense 14-3-3 and TAU protein positivation. The CT scan that was performed did not reveal anything pathological. A cerebral MRI with contrast injection and an EEG were performed. The MRI, which was performed in general anesthesia, revealed: bicerebral cortical cortex hypersignal in diffusion sequence (except the left parietal lobe), with no FLAIR correspondence, without pathological contrast intakes,while EEG highlighted: slow dysrhythmia, delta waves with three phase paroxysmal discharge, Based on these examinations was established the final diagnosis: Probable Sporadic Creutzfeldt Jakob disease. The patient received treatment with valproic acid and clonazepam with no significant improvement.

The Tumoral Etiology of the Superior Cava Vein Syndrome Presenting as Exsudative Pericarditis in a Young Patient

Abstract We present the case of a 36-year-old patient admitted with dyspnea, subjective sensation of edema of the cervical region, and precordial pain with sudden onset. Pathological antecedents revealed a respiratory intercourse three weeks ago. Laboratory findings indicated an inflammatory syndrome accompanied by hypoproteinemia. We performed an echocardiographic examination which revealed important pericardial effusion and swinging heart aspect with diastolic collapse of the right atrium and ventricle. According to the existing guidelines pericardiocentesis was immediately required. The hemorrhagic pericardial effusion had an intense positive Rivalta reaction with frequent macrophages and malignant atypical cells. The next step was a full-body computer tomography scan, which revealed an expansive mediastinal mass, invading the upper cava vein and pericardium, with mediastinal adenopathy. A biopsy was performed and the pathology examination concluded there was a classical Hodgkin’s lymphoma nodular sclerosis type. Finally the patient was directed to oncology department.

Factores relacionados a complicaciones asociadas al uso de ácido tranexámico en pacientes con cirugía de drenaje de hematoma subdural

El hematoma subdural (HSD) es una enfermedad caracterizada por una colección hemática localizada entre la duramadre y aracnoides, ligado a factores de riesgo como edad, hábitos, consumo de anticoagulantes y TEC, siendo algunos de ellos prevenible y modificable. El ácido tranexámico (TXA) es un antifibrinolítico con potente efecto inhibidor sobre la activación de la fibrolisina. En los aspectos del tratamiento de los HSD subagudos y crónicos existen controversias relacionadas no solo al proceder quirúrgico sino también al enfoque actual relacionado a la continuidad terapéutica postcirugía, debido a una multiplicidad de factores intervinientes. Aunque existen reportes de la utilidad del TXA en HSD, deseamos evaluar factores relacionados a complicaciones por su uso a través de un estudio prospectivo concurrente y cuantitativo, de diseño observacional y descriptivo, con corte transversal a través de información recopilada durante 9 meses, con los casos clínicos de 25 pacientes adultos de ambos sexos, mayores de 18 años de edad ingresados por la unidad de Neurocirugía. Como resultados observamos que 76% estuvieron exentos de complicación en el postoperatorio durante su estancia intrahospitalaria, en contraste a 24% que presentaron alguna complicación: fiebre, convulsiones, retiro accidental del sistema de drenaje asociado a neumoencéfalo, agitación psicomotriz, neumonía nosocomial y resangrado. Al alta, 64% egresó con cura completa y 36% conalguna secuela neurológica sin ningún fallecimiento. Concluyéndose que la presencia de antecedentes patológicos o hábitos/psicobiologicos no representaron factores que aumenten la incidencia de complicaciones asociados al uso de TXA por elcontrario, demostró seguridad en el tratamiento de los HSD.

Complicaciones asociadas al uso del ácido tranexámico en el drenaje del hematoma subdural

El hematoma subdural (HSD) es una enfermedad caracterizada por una colección hemática localizada entre la duramadre y aracnoides, ligado a factores de riesgo como edad, hábitos, consumo de anticoagulantes y TEC, siendo algunos de ellos prevenible y modificable. El ácido tranexámico (TXA) es un antifibrinolítico con potente efecto inhibidor sobre la activación de la fibrolisina. En los aspectos del tratamiento de los HSD subagudos y crónicos existen controversias relacionadas no solo al proceder quirúrgico sino también al enfoque actual relacionado a la continuidad terapéutica postcirugía, debido a una multiplicidad de factores intervinientes. Aunque existen reportes de la utilidad del TXA en HSD, deseamos evaluar factores relacionados a complicaciones por su uso a través de un estudio prospectivo concurrente y cuantitativo, de diseño observacional y descriptivo, con corte transversal a través de información recopilada durante 9 meses, con los casos clínicos de 25 pacientes adultos de ambos sexos, mayores de 18 años de edad ingresados por la unidad de Neurocirugía. Como resultados observamos que 76% estuvieron exentos de complicación en el postoperatorio durante su estancia intrahospitalaria, en contraste a 24% que presentaron alguna complicación: fiebre, convulsiones, retiro accidental del sistema de drenaje asociado a neumoencéfalo, agitación psicomotriz, neumonía nosocomial y resangrado. Al alta, 64% egresó con cura completa y 36% conalguna secuela neurológica sin ningún fallecimiento. Concluyéndose que la presencia de antecedentes patológicos o hábitos/psicobiologicos no representaron factores que aumenten la incidencia de complicaciones asociados al uso de TXA por elcontrario, demostró seguridad en el tratamiento de los HSD.

Rosenthal's Disease (Hemophilia C or factor XI Deficiency) Revealed by Chronic Epistaxis: The First Observation in Sub-Saharan Africa.

Objective Rosenthal's disease (RD) is a rare constitutional hemorrhagic disorder defined by factor XI deficiency. It is clinically characterized by the presence of minimal haemorrhage. We report the first observation of RD in Togo. Observation Mrs. G. A., 45 years old with no particular pathological antecedents, was referred for anemia in a context of chronic epistaxis. It was a spontaneous anterior exteriorization epistaxis often of great abundance, rocking and which evolved episodically. The patient received several transfusions for anemia. The ear-nose-throat examination was normal and a sinus CT scan found only an inflammatory process of the right maxillary sinus. The blood count showed microcytic severe anemia (2,2g/dl). Hemostasis tests showed a prolonged aPTT (57,9 seconds). Clinical examination documented an anemic syndrome with dry skin. Iron deficiency was found. The hemostasis balance confirmed aPTT elongation. Coagulation factors activity showed normal VIII and IX level, but moderate decrease of factor XI (32%). The family survey was not possible (orphan patient). It is recommended the setting under fresh frozen plasma (FFP) in case of a new episode. Follow-up is in progress. Conclusion In the event of any hemorrhagic syndrome, the isolated elongation of the aPTT must lead to a systematic analysis of intrinsic pathway factors

Prevalencia de dislipidemia y riesgo cardiovascular en pacientes con diabetes mellitus tipo 2

<p><strong>Objetivo:<em> </em></strong>determinar la prevalencia de dislipidemia y riesgo cardiovascular (rcv) en pacientes con diabetes mellitus tipo 2 (dm2). <strong>Métodos:<em> </em></strong>estudio transversal analítico, se evaluaron datos de 875 pacientes derechohabientes de la Unidad de Medicina Familiar (umf) no. 31 del imss de la Ciudad de México durante el mes de julio de 2017. Se incluyeron pacientes con diagnóstico de dm2. Se analizaron parámetros bioquímicos y antropométricos para obtener la prevalencia de alteraciones lipídicas y el rcv. Se recabaron datos demográficos y antecedentes patológicos. Se realizó estadística descriptiva, cálculo de <span>χ<sup>2</sup></span> y razón de momios (rm). <strong>Resultados:<em> </em></strong>se evaluaron datos de 607 mujeres y 268 hombres, se obtuvo una mediana de edad de 57.24 años (rango intercuartil [ri] 51 a 63). La prevalencia de dislipidemia fue de 41% (n=359). El<strong> </strong>rcv<strong> </strong>severo tuvo una prevalencia de 34.2% (n=300). La hipertrigliceridemia y la enfermedad renal crónica (erc) estadio 3 estuvieron asociadas con<strong> </strong>rcv severo (p<0.05). <strong>Conclusiones:<em> </em></strong>la prevalencia de dislipidemia es alta en los pacientes con dm2 y el riesgo cardiovascular severo afecta a un tercio de esta población. Se recomienda implementar medidas para disminuir dicha prevalencia y mejorar la calidad y esperanza de vida de los pacientes.</p>

Características sociodemográficas y clínicas y antecedentes patológicos asociados a infección del tracto urinario en diabéticos

Objetivo. Determinar qué características sociodemográficas y clínicas y antecedentes patológicos constituyen un mayor riesgo para tener infección del tracto urinario (ITU), según el estudio de casos/controles, en población diabética tipo 2. Material y MétOdOs. Estudio comparativo, transversal, retrospectivo y explicativo realizado en el servicio de medicina interna del Hospital Loayza el año 2016. Se revisaron historias de 163 pacientes diabéticos con ITU y 163 diabéticos sin ITU. Se aplicó ji cuadrado inicialmente y luego regresión logística con estadístico de Wald para análisis multivariado. resultadOs. Las características sociodemográficas no tuvieron relación estadística con la ocurrencia de ITU (p > 0,05). El tiempo de enfermedad ≥ 10 años (OR = 3,978 (IC95% 1,467-10,790); p = 0,007), la insuficiencia renal crónica (OR = 8,412 (IC95% 1,832-38,615), p = 0,006), la litiasis renal (OR = 10,604 (IC95% 2,144-52,459), p = 0,004), la vejiga neurogénica (OR = 12,290 (IC95% 1,447-104,386), p = 0,022), el uso de corticoides (OR = 17,850 (IC95% 3,789-84,087), p = 0,000), la ITU previa (OR = 27,757 (IC95% 9,280-83,027), p = 0,000) y la infección vaginal o la patología prostática (OR=4,958 (IC95% 2,149-11,439), p = 0,000) estuvieron asociados de forma independiente con la ocurrencia de ITU. COnClusión. Las características sociodemográficas no tienen relación estadística con ITU. Un tiempo de enfermedad de 10 años o más, la insuficiencia renal crónica, litiasis renal, vejiga neurogénica, uso de corticoides, ITU previa e infección vaginal o patología prostática están asociadas estadísticamente con la ocurrencia de ITU en la población de diabéticos tipo 2.

Atipias de células escamosas de significado incierto (ASCUS) y lesión escamosa intraepitelial de bajo grado (LSIL). Control citológico evolutivo a 3 meses. Resultados

ObjectiveProspective study of 4 years (2015-2018) of the ASCUS and LSIL cases in the vaginocervical cytology, and your evolutive cytological control in 3 months. DesignStudy of: age, parity, nulligravides, menopausal, contraceptive methods, sexuality and sexual dysfunctions, pathologic antecedents, cytology and HPV (human papillomavirus) analysis, comparing the evolution in both groups. ResultsThe series are 146 cases of ASCUS and 82 cases of LSIL.In ASCUS, there were significant differences in age (P<.02), parity (P<.001), and abortions (P<.02). In LSIL, there were significant differences in nulligravides (P<.001).There were significant differences (P<.02) in condom use in LSIL. In both groups more of 50% of the cases dońt use any contraceptive method There were no significant differences in sexuality nor in sexual dysfunctions, neither in antecedents.ASCUS was associated with infections in 15,05%. LSIL was associated with infections in 9,74%, without differences.There were significant differences in negative HPV (P<.001) in ASCUS, 43,15% versus 20,73% in LSIL. There were significant differences in High Risk other viruses positive (P<.001) in LSIL.In the cytologic control at 3 monts, there were significant differences in ASCUS+BV (bacterial vaginosis) (P<.02) in LSIL. Also in LSIL group there were more LSIL in the cytologic control at 3 months, 26,82% (P<.01).In the follow-up at 1 year, there were no significant differences. The negative cytology was in 64,86% and 47,82%, respectively. ConclusionThe reiterative cytology in 3 months are value for detecting the associated infections, and treated; to run over and advance the cytologic normality.

Factores asociados a malnutrición en niños entre 2 y 5 Años Oicatá, Colombia

Introducción. La malnutrición se define como una serie de desequilibrios que incluyen desde la desnutrición, déficit proteico o calórico, sobrepeso y obesidad. Objetivo: Determinar los factores clínicos y sociodemográficos asociados a la prevalencia de malnutrición en niños entre 2 y 5 años, en el periodo 2016-2017, en la Empresa Social del Estado (E.S.E) de primer nivel, Oicatá, Boyacá. Método. Estudio de prevalencia analítica, con un muestro aleatorio de 194 niños y niñas, entre los 2 y 5 años, suministrado por la base de datos de controles de crecimiento y desarrollo entre los años 2016 y 2017. Resultados. De los 194 niños incluidos en la investigación, el género de mayor predominio fue el femenino en un 50,5%, con una media de edad 4 años y un Índice de Masa Corporal de 15.35 (kg/cm2). Se halló una prevalencia para desnutrición aguda y crónica de 1,2% y 1,8% respectivamente, asociada a factores como antecedentes patológicos, nacimiento por cesárea, bajo peso al nacer, parto pre término y una lactancia materna menor a 2 meses. Se encontraron más cifras de malnutrición por déficit que por exceso. Conclusiones. La prevalencia de malnutrición en el municipio de Oicatá, evidenció mayores cifras hacia la desnutrición crónica y su existencia con la asociación a múltiples factores clínicos y sociodemográficos para padecer tal condición en los menores de 5 años

Tamponade revealing hydatid cyst of the left ventricle

The hydatid disease is endemic in certain areas of the world such as the Mediterranean basin. We report the observation of cardiac hydatidosis revealed by pericardial effusion. A 49 year old man, with no particular pathological antecedents, consulted for progressive dyspnea since 3 months. In cardiac echocardiography, we noticed the presence of an abundant pericardial effusion in pre-tamponade. A pericardial puncture indicated urgently was performed. Thoracoabdominal CT scan showed a multivesicular hydatious cyst of type 3 interesting the superior part of the left ventricle. The patient was put on medical treatment (Albendazole®) and referred to surgery for management.

Hypoglycemia Controlled by Prednisone in an Occult Insulinoma or a Nesidioblastosis

Insulinoma is a pancreatic endocrine tumor lower in size than 20 mm in 80% of the cases and his treatment is chirurgical. However, in certain circumstances such as an occult location or circumstances of metastases, medical treatment is called for. Observation: A 29 years old patient with no specific pathological antecedents has presented severe hypoglycemia mainly in the morning. A patient was in a generally good condition. The fasting test revealed an inappropriate secretion of insulin at a venous glycemia of 0.35 g/l; which was corroborated by Turner index and altered glucose insulin index that we calculated. Moreover, the 8 h cortisolemia was normal at 90.13 ng/l, the TSH was normal at 1.44 μui/l, anti-insulin antibodies were negative at 6.7 U/l; the search of hypoglycemic sulfonamides was negative. Morphologically, she had three pancreatic tomodensitometry these were normal. She also had echo-endoscopy which showed a normal pancreas. The surgical exploration with preoperative echo is advised only after surgeon’s assessment when the technical conditions are not put together. The diagnosis of the occult insulinoma or of nesidioblastosis was retained. The medical treatment was retained. Due to the unavailability of diazoxide in our pharmacies and the high cost of analogs of somatostatine, she was provided with prednisone 0.5 mg/kg/24h which was 40 mg/day after common agreement. The evolution was favorable. Conclusion: It should be noticed that medical treatment can be suggested if insulinoma is not localized. This observation proves that the localization of the insulinoma can be unsuccessful. It should also be noticed that our experience is the fourth described in literature, where hypoglycemia in insulinomas is controlled by prednisone.

Severity scores in trauma patients admitted to ICU. Physiological and anatomic models

IntroductionThe goals of this project were to compare both the anatomic and physiologic severity scores in trauma patients admitted to intensive care unit (ICU), and to elaborate mixed statistical models to improve the precision of the scores. MethodsA prospective study of cohorts. The combined medical/surgical ICU in a secondary university hospital. Seven hundred and eighty trauma patients admitted to ICU older than 16 years of age. Anatomic models (ISS and NISS) were compared and combined with physiological models (T-RTS, APACHE II [APII], and MPM II). The probability of death was calculated following the TRISS method. The discrimination was assessed using ROC curves (ABC [CI 95%]), and the calibration using the Hosmer–Lemeshow's H test. The mixed models were elaborated with the tree classification method type Chi Square Automatic Interaction Detection. ResultsA 14% global mortality was recorded. The physiological models presented the best discrimination values (APII of 0.87 [0.84–0.90]). All models were affected by bad calibration (p<0.01). The best mixed model resulted from the combination of APII and ISS (0.88 [0.83–0.90]). This model was able to differentiate between a 7.5% mortality for elderly patients with pathological antecedents and a 25% mortality in patients presenting traumatic brain injury, from a pool of patients with APII values ranging from 10 to 17 and an ISS threshold of 22. ConclusionsThe physiological models perform better than the anatomical models in traumatic patients admitted to the ICU. Patients with low scores in the physiological models require an anatomic analysis of the injuries to determine their severity.

Retrospective Cohort Research: Abdominal Hysterectomy vs Vaginal Hysterectomy, Analysis of Hospital Complications. San Francisco de Quito Hospital. Quito - Ecuador, 2014 – 2015

BACKGROUND: Hysterectomy is the surgical removal of the uterus, whose surgical techniques have evolved over time; it is one of the most frequent gynecological surgeries in the world. The objective of the study was to evaluate the frequency of postsurgical complications through the approach and correlate them with risk factors. METHODS: A retrospective study was designed. The total number of women surgically undergoing hysterectomy was selected during the years 2014 and 2015. The universe consisted of 409 women undergoing surgery, of whom a sample of 384 was obtained at the Gynecology Department. The statistical analysis was realized in the statistical tool SPSS 17.0. In the analysis of the results, U Mann-Whitney test, Chi square and Relative Risk were used. RESULTS: It was obtained that the average age was 85 % with an age under 50 years. The average time of surgical procedure was 104 minutes, and an average hospitalization time of 2.7 days. The pathological antecedents were the gynecological-obstetric surgery previous 62 %. 88 % of the hysterectomies. The total incidence of complications due to hysterectomy in general was 3.38 %; 100 % of complications occurred in abdominal hysterectomy. There was no significant statistical correlation with risk factors such as obesity (P 0.15 and RR: 0.39). CONCLUSIONS: Vaginal hysterectomy has fewer postsurgical complications, less days of hospitalization and a shorter surgical time compared to the abdominal approach; however, abdominal hysterectomy is the most frequent of treatment choice. It is recommendable to realize more studies in other health institutions in Ecuador.

Familial hypercholesterolemia revealed by multiple xanthomas

Familial hypercholesterolemia (HF) is a rare pathology characterized by a major elevation of LDL associated with tendinous and subcutaneous xanthomas. We report the case of a 16-year-old patient, born from a first degree consanguineous marriage, with no particular pathological antecedents, the patient reports appearance for 9 years of cutaneous lesions described as a swellings in the posterior face of the 2 elbows and the anterior surface of the 2 knees, painless, firm, and gradually increasing in volume. The patient consulted only at the age of 16 years in front of the aesthetic discomfort. The biological assessment objectified a hypercholesterolemia: total Cholesterol: 4.44g/l. HDL: 0.64g/l. LDL: 3.71g/l. and Triglycerides: 0.67g/l. The exploration of cardiac repercussion was without particularities.The patient was treated with dietary and lifestyle measures and atorvastatin 80 mg with good clinical and biological evolution.

Single Pulmonary Nodule Management: Experience of a Moroccan Center about 24 Patients

Introduction: The management of single pulmonary nodule remains difficult, since it is of multiple etiologies. The endemicity of tuberculosis and hydatidosis in our context makes the etiological orientation even more difficult. Materials and Methods: This is a retrospective study, involving 24 patients, all operated on for a single pulmonary nodule in the department of thoracic surgery of CHU Hassan II of Fez over a period of 8 years. Results: There were 15 men and 9 women, with an average age of 51 years. 45.4% of patients had a history of known neoplasia. Discovery was fortuitous in 54% of cases. The radiologic diagnosis based on thoracic computed tomography had objectified an isolated nodule in all the patients with a right localization in 71% of the cases It was a solid pulmonary nodule in 91.5% of cases, and a frosted glass appearance in 8.5%. Bronchial fibroscopy was contributory in one case which was a carcinoid tumor. The approach was a conservative postero-lateral thoracotomy in 22 patients. The gesture was atypical resection in 67%, and lobectomy in 24.5% of cases, in the context of centrilobular nodules. The etiologies were dominated by pulmonary metastases in 29% of cases, pulmonary tuberculosis in 21% of cases. The postoperative course was simple in all patients. Conclusion: The pathological antecedents and the characteristics of the nodule on the imaging are essential elements allowing an etiological orientation. However, the pathological study remains the only method to confirm the diagnosis.

Lambeau fascio-cutané de la face interne de la cuisse dans la reconstruction des pertes de substances périnéo-scrotales

Perineal and scrotal gangrene is an acute, severe and rapidly extensive disease. The treatment of the acute phase often causes a loss of extended substance (A, B) which often poses problems in secondary reconstruction. Thus different types of treatment may be proposed: the controlled healing, skin transplant, burying the testes, and locoregional flaps which may be fasciocutaneous or musculocutaneous. We report the case of a patient with loss of scrotal substance whose cover was done by a fasciocutaneous flap of the inner thigh. The patient, aged 70 years, without pathological antecedents underwent surgery for Fournier gangrene of the scrotum. After treating the acute phase with left orchiectomy, the patient showed a defect in scrotal substance (A, B) and in the underside of the penis whose reconstruction was performed by a fasciocutaneous flap of the inner thigh. Post-operative suites were simple, and the patient was very satisfied with the result. The fasciocutaneous flap of the inner thigh is an ideal flap for reconstruction of perineal and scrotal substances loss, it is vascularized by branches of the pudendal artery, it is simple, easy to perform, very reliable with satisfactory aesthetic results (C). It allows the use of a skin paddle measuring 9 × 20 cm, but it requires a second withdrawal intervention (D).

Correlations between diabetes mellitus and sexual dysfunction disorders

Disorders of male sexual dynamics are associated with a number of cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, or smoking. Diabetes mellitus is a frequent cause of erectile dysfunction, through complex mechanisms. It is considered that diabetes doubles the risk for an erectile dysfunction, and this can develop a decade earlier than in other men. The mechanisms implicated include the involvement of the large and small vessels, but also the diabetic neuropathy. Often, the erectile dysfunction draws the attention to a possible diabetes mellitus. The incidence of erectile dysfunction in Romania was estimated at 3% for young people aged 15-25, 7% for those aged 25 to 45 and 22% for men aged 45-55 years old. It is estimated that 150 million men worldwide suffer from erectile dysfunction and their number will double by 2025. For diabetic patients, the prevalence of erectile dysfunction is more than 50%. The purpose of this paper is to analyze the association of erectile dysfunction with diabetes mellitus and its major comorbidities, dyslipidemia and hypertension. The study is retrospective, with data from 1385 patients being collected during the 2005-2014 period, which showed sexual dysfunction. The data analyzed were collected anamnestically and refer to the presence of risk factors and personal pathological antecedents. The age of patients with sexual dysfunction was between 18 and 86 years old, of which 284, or 20.50%, had hyperglycemia. In 8.44% of all patients, the association of erectile dysfunction with diabetes mellitus, dyslipidemia and hypertension was present, in 13.57% the erectile dysfunction was as­so­cia­ted with diabetes mellitus and hypertension, and in 24.69% only with hypertension and dyslipidemia. Of the car­dio­vas­cular risk factors, hypertension is most commonly as­sociated with erectile dysfunction, and the most com­monly associated risk factor for high blood pressure is dyslipidemia. However, the study also revealed that of the 284 patients with hyperglycemia and erectile dysfunction, 60.21% were new cases of hyperglycemia. Thus, we can say that in most cases with diabetes or hyperglycemia, erectile dysfunction preceded the detection of metabolic disease.