Clinical approach after identification of a rare anti-Ena in a prenatal sample.

CONCLUSIONS: The antigens associated with the MNS blood group system (ISBT 002) are located on glycophorin A (GPA) and glycophorin B (GPB). The most frequently encountered antibodies to antigens in this system by a transfusion medicine service are those directed against M, N, S, and s. Individuals lacking GPA typically have red blood cells that lack M, N, and Ena, whereas those lacking both GPA and GPB lack M, N, and Ena as well as S, s, and U. Such individuals may develop a rare antibody, anti-Ena, directed against determinants on GPA. This antibody is capable of causing hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. This case report describes a pregnant woman found to have anti-Ena. Molecular testing supported an Mk phenotype that was found in several members of her immediate family.

A novel mortality risk score for emphysematous pyelonephritis: A multicenter study of the Global Research in the Emphysematous Pyelonephritis group.

Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and the surrounding tissues associated with considerable mortality. We aimed to formulate a score that classifies the risk of mortality in patients with EPN at hospital admission. Materials and methods: Patients diagnosed with EPN between 2013 and 2020 were retrospectively included. Data from 15 centers (70%) were used to develop the scoring system, and data from 7 centers (30%) were used to validate it. Univariable and multivariable logistic regression analyses were performed to identify independent factors related to mortality. Receiver operating characteristic curve analysis was performed to construct the scoring system and calculate the risk of mortality. A standardized regression coefficient was used to quantify the discriminating power of each factor to convert the individual coefficients into points. The area under the curve was used to quantify the scoring system performance. An 8-point scoring system for the mortality risk was created (range, 0-7). Results: In total, 570 patients were included (400 in the test group and 170 in the validation group). Independent predictors of mortality in the multivariable logistic regression were included in the scoring system: quick Sepsis-related Organ Failure Assessment score ≥2 (2 points), anemia, paranephric gas extension, leukocyte count >22,000/µL, thrombocytopenia, and hyperglycemia (1 point each). The mortality rate was <5% for scores ≤3, 83.3% for scores 6, and 100% for scores 7. The area under the curve was 0.90 (95% confidence interval, 0.84-0.95) for test and 0.91 (95% confidence interval, 0.84-0.97) for the validation group. Conclusions: Our score predicts the risk of mortality in patients with EPN at presentation and may help clinicians identify patients at a higher risk of death.

Computed tomography scan in supine and prone positions: an alternative method to detect intramural gas in emphysematous cystitis and to evaluate efficacy after adjuvant continuous intravesical irrigation treatment.

OBJECTIVE: To evaluate the efficacy of continuous intravesical irrigation with saline plus amikacin as adjuvant therapy and to evaluate the computed tomography (CT) scan in supine and prone positions (CystoCT scan) as an alternative diagnostic and evaluation method of intramural gas in emphysematous cystitis (EC) before and after treatment. METHODS: Consecutive patients with a diagnosis of EC who were hospitalized between March 2006 and January 2011 were investigated. The diagnosis was made by CystoCT scan. Treatment consisted of intravenous antibiotics, control of concomitant diseases, and placement of a 3-way urinary catheter for continuous irrigation of 500 mg of amikacin diluted in 1 l of saline given on days 0, 3, and 7. Treatment was considered successful when there was an absence of gas in the bladder wall, the urine culture was negative, there was clinical improvement, and there was an absence of toxicity. RESULTS: Eleven patients were hospitalized with a diagnosis of EC during the study period. Four were excluded from the study, 2 due to the lack of confirmation of the diagnosis with the CystoCT scan. Treatment was successful in all patients; for 6 (86%) this was achieved in 3 days and for 1 (14%) in 7 days. No toxicity was reported. CONCLUSIONS: Continuous intravesical irrigation with saline plus amikacin as adjuvant treatment of EC is an inexpensive, effective, and safe tool that might help conventional treatment and provide a rapid recovery. The CystoCT scan is an alternative method to diagnose and evaluate intramural gas in EC patients. These findings should be challenged in a randomized, multi-centre, placebo-controlled clinical trial.

Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia.

OBJECTIVES: To evaluate the management of acute urinary retention (AUR) associated with benign prostatic hyperplasia (BPH) in real-life practice. To identify predictors of successful trial without catheter (TWOC). MATERIALS AND METHODS: In all, 6074 men catheterized for painful AUR were enrolled in a prospective, cross-sectional survey conducted in public and private urology practices in France, Asia, Latin America, Algeria and the Middle East. Patient clinical characteristics, type of AUR and its management (type of catheterization, hospitalization, TWOC, use of α(1)-blockers, immediate or elective surgery) and adverse events observed during the catheterization period were recorded. Predictors of TWOC success were also analysed by multivariate regression analysis with stepwise procedure. RESULTS: Of the 6074 men, 4289 (71%) had a spontaneous AUR and 1785 (29%) had a precipitated AUR, mainly as the result of loco-regional/general anaesthesia (28.5%) and excessive alcohol intake (18.2%). Presence of BPH was revealed by AUR in 44% of men. Hospitalization for AUR varied between countries, ranging from 1.7% in Algeria to 100% in France. A urethral catheter was inserted in most cases (89.8%) usually followed by a TWOC (78.0%) after a median of 5 days. Overall TWOC success rate was 61%. Most men (86%) received an α(1)-blocker (mainly alfuzosin) before catheter removal with consistently higher TWOC success rates, regardless of age and type of AUR. Multivariate regression analysis confirmed that α(1)-blocker before TWOC doubled the chances of success (odds ratio 1.92, 95% CI 1.52-2.42, P < 0.001). Age ≥70 years, prostate size ≥50 g, severe lower urinary tract symptoms, drained volume at catheterization ≥1000 mL and spontaneous AUR favoured TWOC failure. Catheterization >3 days did not influence TWOC success but was associated with increased morbidity and prolonged hospitalization for adverse events. In the case of TWOC failure, 49% of men were recatheterized and had BPH surgery and 43.5% tried another TWOC with a success rate of 29.5%. Elective surgery was preferred to immediate surgery. CONCLUSIONS: TWOC has become a standard practice worldwide for men with BPH and AUR. In most cases, an α(1)-blocker is prescribed before TWOC and significantly increases the chance of success. Prolonged catheterization is associated with an increased morbidity.

What is the prognosis of emphysematous pyelonephritis associated with extended-spectrum beta-lactamases producing microorganisms?

Objective: To describe the microbiological characteristics in emphysematous pyelonephritis (EPN), demonstrate the frequency of extended-spectrum beta-lactamase (ESBL) microorganisms, and determine if these microorganisms are associated with the prognosis of patients with EPN. Methods: We conducted a retrospective study in patients with a diagnosis of EPN in a tertiary care hospital of the northeast region of Mexico during the period from January 2011 to January 2016. Clinical variables were analyzed to determine association with the presence of ESBL-producing microorganisms. Statistical significance was set with p<0.05. Results: A total of 63 patients were included; 55 (87.3%) of them were females, with a median age of 55 (interquartile range: 45-65) years. Conservative management was indicated in 38.1%; 42.9% were treated with ureteral stent; 12.7% with open or percutaneous drainage; 15.8% with early nephrectomy; and 9.5% with delayed nephrectomy. Reported mortality was 13 (20.6%) cases; 23 (36.5%) cases required admission to the intensive care unit. The most frequent microorganism isolated was Escherichia coli (n=34, 53.9%). ESBL microorganisms were found in 31.7% of the population. No significant association of ESBL was found with admission to the intensive care unit, or with increased mortality. Conclusions: To our knowledge, this is the first study that evaluates ESBL microorganisms as a prognostic factor in EPN. Risk factors associated with a poor prognosis in patients with EPN have been described. The microbiological factors, specifically ESBL-producing bacteria, do not seem to influence in the prognosis of these patients.

Prognosis of Extended-Spectrum-Beta-Lactamase-Producing Agents in Emphysematous Pyelonephritis-Results from a Large, Multicenter Series.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and surrounding tissues with significant mortality. We aimed to assess the clinical factors and their influence on prognosis in patients being managed for EPN with and without ESBL-producing bacteria and to identify if those with EPN due to ESBL infections fared any different. METHODS: A retrospective analysis was performed on patients with EPN diagnosis from 22 centers across 11 countries (between 2013 and 2020). Demographics, clinical presentation, biochemical parameters, radiological features, microbiological characteristics, and therapeutic management were assessed. Univariable and multivariable analyses were performed to determine the independent variables associated with ESBL pathogens. A comparison of ESBL and non-ESBL mortality was performed evaluating treatment modality. RESULTS: A total of 570 patients were included. Median (IQR) age was 57 (47-65) years. Among urine cultures, the most common isolated pathogen was Escherichia coli (62.2%). ESBL-producing agents were present in 291/556 urine cultures (52.3%). In multivariable analysis, thrombocytopenia (OR 1.616 95% CI 1.081-2.413, p = 0.019), and Huang-Tseng type 4 (OR 1.948 95% CI 1.005-3.778, p= 0.048) were independent predictors of ESBL pathogens. Patients with Huang-Tseng Scale type 1 had 55% less chance of having ESBL-producing pathogens (OR 1.616 95% CI 1.081-2.413, p = 0.019). Early nephrectomy (OR 2.3, p = 0.029) and delayed nephrectomy (OR 2.4, p = 0.015) were associated with increased mortality in patients with ESBL infections. Conservative/minimally invasive management reported an inverse association with mortality (OR 0.314, p = 0.001). CONCLUSIONS: ESBL bacteria in EPN were not significantly associated with mortality in EPN. However, ESBL infections were associated with poor prognosis when patients underwent nephrectomy compared conservative/minimally invasive management.

Emphysematous Pyelonephritis and Emphysematous Cholecystitis: A Result of Uncontrolled Type 2 Diabetes.

Background: Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing infection that results in the presence of gas in the renal parenchyma, collecting system, and surrounding tissues. Up to 95% of patients with EPN have underlying uncontrolled diabetes mellitus. Emphysematous cholecystitis (EC) is a necrotizing infection defined by the presence of gas in the gallbladder. Concurrent presentation of EPN and EC is limited to anecdotal cases in the literature. Case Report: We present the case of a 44-year-old female who arrived at the emergency department with signs of septic shock and diffuse abdominal pain. Diagnosis of EPN and EC was confirmed. Because the patient did not improve after aggressive medical therapy and percutaneous drainage and cholecystostomy, she was taken to surgery for emergency nephrectomy and cholecystectomy. Conclusion: In unusually extensive and severe cases of EPN, medical and minimally invasive procedures are not enough to control the infection. More aggressive management, including emergency surgery, should be implemented in selected patients who present with refractory septic shock associated with extensive disease.

Collision Tumor of the Kidney: Renal Cell Carcinoma Hidden in a Giant Angiomyolipoma in a Patient With Tuberous Sclerosis Complex.

Background: A renal angiomyolipoma is a mixed mesenchymal benign tumor composed of smooth muscle, adipose tissue, and blood vessels. Malignant transformation of angiomyolipomas is anecdotal. To our knowledge, only 6 cases have been reported, and 4 of the patients had tuberous sclerosis complex diagnosed. Case Report: We present the case of a 29-year-old male with tuberous sclerosis complex who arrived at the emergency room with gross hematuria and a painful right-sided abdominal mass. Imaging studies revealed active bleeding from a giant angiomyolipoma. An emergency nephrectomy was performed. Histopathology evaluation revealed an angiomyolipoma with a focal lesion and clear cell renal carcinoma within the tumor. Conclusion: Limited evidence is available to dictate management of collision tumors of the kidney in the scenario of tuberous sclerosis complex, so a multidisciplinary approach that includes urology, oncology, genetics, and nephrology intervention needs to be considered. No standardized follow-up modality has been established for angiomyolipomas, so patients should be placed under active surveillance, similar to that carried out in cases of renal cell carcinoma.

Identification of viral infections in the prostate and evaluation of their association with cancer.

BACKGROUND: Several viruses with known oncogenic potential infect prostate tissue, among these are the polyomaviruses BKV, JCV, and SV40; human papillomaviruses (HPVs), and human cytomegalovirus (HCMV) infections. Recently, the Xenotropic Murine Leukemia Virus-related gammaretrovirus (XMRV) was identified in prostate tissue with a high prevalence observed in prostate cancer (PC) patients homozygous for the glutamine variant of the RNASEL protein (462Q/Q). Association studies with the R462Q allele and non-XMRV viruses have not been reported. We assessed associations between prostate cancer, prostate viral infections, and the RNASEL 462Q allele in Mexican cancer patients and controls. METHODS: 130 subjects (55 prostate cancer cases and 75 controls) were enrolled in the study. DNA and RNA isolated from prostate tissues were screened for the presence of viral genomes. Genotyping of the RNASEL R462Q variant was performed by Taqman method. RESULTS: R/R, R/Q, and Q/Q frequencies for R462Q were 0.62, 0.38, and 0.0 for PC cases and 0.69, 0.24, and 0.07 for controls, respectively. HPV sequences were detected in 11 (20.0%) cases and 4 (5.3%) controls. XMRV and HCMV infections were detected in one and six control samples, respectively. The risk of PC was significantly increased (Odds Ratio = 3.98; 95% CI: 1.17-13.56, p = 0.027) by infection of the prostatic tissue with HPV. BKV, JCV, and SV40 sequences were not detected in any of the tissue samples examined. CONCLUSIONS: We report a positive association between PC and HPV infection. The 462Q/Q RNASEL genotype was not represented in our PC cases; thus, its interaction with prostate viral infections and cancer could not be evaluated.

The use of Butea superba (Roxb.) compared to sildenafil for treating erectile dysfunction.

OBJECTIVE: To evaluate the effect of an extract of Butea superba (Roxb.) (BS) compared to sildenafil for treating erectile dysfunction (ED). PATIENTS AND METHODS: An open label study was carried out among 32 men with organic ED to evaluate the response on the International Index of Erectile Function 5 (IIEF-5) to BS, a 'natural health' product (100 mg), compared to 50 mg of sildenafil (a phosphodiesterase-5 inhibitor). After a 1-week wash-out, responders to BS received either 100 mg starch or 100 mg of another batch of BS (double-blind). RESULTS: Of the patients in the BS group, 27 (84%) responded positively, compared with 26 (81%) in the sildenafil group. When assessing the score alone, 12 (38%) had a better score after taking BS, compared to seven (22%) after sildenafil, and eight (25%) had the same score. The results were surprising and could not be repeated in the double-blind part of the study, where no effect of BS was recorded. CONCLUSIONS: A 'natural' health product containing BS was more effective than sildenafil in the first part of the study, but in the second, using another batch of BS, the positive result could not be repeated and no effect was recorded. The conclusion is that the first preparation of BS was most likely blended with a phosphodiesterase-5 inhibitor, later confirmed by the supplier of BS (a natural health products company) after their own analysis.

Prospective study of prostate cancer's detection rate at our hospital in Northeast Mexican patients with PSA values between 2.6 y 4 ng/ml.

UNLABELLED: SUMMAR OBJECTIVES: To find the detection rate of prostate cancer (PCa) in our population with PSA values between 2.6 and 4 ng/ml. METHODS: We included 33 consecutive patients with a median age of 66 years, that had a Transrectal Ultrasound (TRUS) guided biopsy with PSA between 2.6-4 ng/ml. Patients were divided into 2 groups. Group 1: patients with normal Digital Rectal Examination (DRE) and Group 2: Patients with DRE with asymmetry not definitive of PCa. EXCLUSION CRITERIA: known history of PCa, intraepithelial neoplasia or Positive DRE. Statistical analysis/ Chi square, t-student and Fischer exact test. RESULTS: Twenty eight percent of the patients had positive biopsy for PCa. Fifty six percent were Gleason 6 and 44% Gleason 7. Group 1 had 59%(20) and Group 2 41% (13) in. In Group 1 16% had positive biopsy for PCa vs 46% in group 2 (p 0.04) RR 3.07. CONCLUSIONS: There are traces that the detection rate in our population could be lower in comparison with what has been reported in the literature. DRE is crucial in the initial evaluation; asymmetry could increase 3 fold the risk of having PCa.

[Relationship between testicular microcalcifications and clinical characteristics in patients with testicular cancer]. / Relación entre microlitiasis testiculares y características clínicas en sujetos con cáncer testicular.

INTRODUCTION: Testicular microlithiasis (TM) is an uncommon finding in general male population. These calcifications are reported by testicular ultrasound performed by some testicular pathology and constitute an incidental finding. The presence of TM is regularly associated to testicular neoplasms. OBJECTIVES: To investigate the relationship between clinical and demographic factors, comorbidities and tumor biomarkers, and the presence or absence of microlithiasis in patients with testicular cancer. MATERIAL AND METHODS: A retrospective study including a total of 66 patients diagnosed with testicular carcinoma from 2012 to 2017 in a hospital in Northeastern Mexico. The total of patients was divided into 2 groups according to the presence or absence of MT and the clinical features of these were analyzed. RESULTS: There was a general prevalence of TM of 31.8%. The main tumor found in the pathology reports corresponded to the non seminomatous germ cells tumor (54.4%). The incidence of metastasis to organs was of 27.3%. No statistically significant differences were found when comparing the variables of interest in the group with and without MT. A relationship was found between the elevation of alpha-fetoprotein and non-seminomatous tumors compared to seminomatous tumors (PY=Y.003). CONCLUSIONS: According to the results obtained, it can be suggested that TM is a clinical finding that is not related to the prognosis of the disease or any of the comorbidities and clinical data analyzed in our study.

Steroid 5 alpha-reductase 2 enzyme variants, biomass exposure and tobacco use in Mexican patients with prostate cancer.

The presence of the genetic variants of the steroid 5-alpha reductase 2 enzyme, which is encoded by the SRD5A2 gene, has been associated with an increased risk of developing prostate cancer among certain ethnic groups. However, these molecular studies have not been conducted on the Mexican population. The analysis of the genetic variants, rs9282858 and rs523349, was performed in 101 males with prostate cancer and 100 healthy controls classified as males without prostate abnormalities (n=60) and males with benign prostatic hyperplasia (n=40), to identify a probable association with this cancer type in the Northeast Mexican population. An association was identified between prostate cancer and biomass exposure [P=0.012; odds ratio (OR), 2.89; confidence interval (CI)=1.21-6.88] and tobacco use (P=0.028; OR=1.88; CI=1.07-3.31), while no association was observed between cancer development and the rs9282858 variant, or between a protective effect and the rs523349 variant. Notably, an association was identified between rs523349 and biomass exposure (P=0.013, OR=3.17; CI=1.23-8.17 for the G risk allele, and OR=0.32, CI=0.12-0.81 for the C protective allele) using the dominant genetic model. To the best of our knowledge, the present study was the first of its type to investigate the Mexican population with prostate cancer.

Characterization of a novel automated microfiltration device for the efficient isolation and analysis of circulating tumor cells from clinical blood samples.

The detection and analysis of circulating tumor cells (CTCs) may enable a broad range of cancer-related applications, including the identification of acquired drug resistance during treatments. However, the non-scalable fabrication, prolonged sample processing times, and the lack of automation, associated with most of the technologies developed to isolate these rare cells, have impeded their transition into the clinical practice. This work describes a novel membrane-based microfiltration device comprised of a fully automated sample processing unit and a machine-vision-enabled imaging system that allows the efficient isolation and rapid analysis of CTCs from blood. The device performance was characterized using four prostate cancer cell lines, including PC-3, VCaP, DU-145, and LNCaP, obtaining high assay reproducibility and capture efficiencies greater than 93% after processing 7.5 mL blood samples spiked with 100 cancer cells. Cancer cells remained viable after filtration due to the minimal shear stress exerted over cells during the procedure, while the identification of cancer cells by immunostaining was not affected by the number of non-specific events captured on the membrane. We were also able to identify the androgen receptor (AR) point mutation T878A from 7.5 mL blood samples spiked with 50 LNCaP cells using RT-PCR and Sanger sequencing. Finally, CTCs were detected in 8 out of 8 samples from patients diagnosed with metastatic prostate cancer (mean ± SEM = 21 ± 2.957 CTCs/mL, median = 21 CTCs/mL), demonstrating the potential clinical utility of this device.

Population based prostate cancer screening in north Mexico reveals a high prevalence of aggressive tumors in detected cases.

BACKGROUND: Prostate Cancer (PCa) is the second most frequent neoplasia in men worldwide. Previous reports suggest that the prevalence of PCa in Hispanic males is lower than in Africans (including communities with African ancestry) and Caucasians, but higher than in Asians. Despite these antecedents, there are few reports of open population screenings for PCa in Latin American communities. This article describes the results of three consecutive screenings in the urban population of Monterrey, Mexico. METHODS: After receiving approval from our University Hospital's Internal Review Board (IRB), the screening was announced by radio, television, and press, and it was addressed to male subjects over 40 years old in general. Subjects who consented to participate were evaluated at the primary care clinics of the University Health Program at UANL, in the Metropolitan area of Monterrey. Blood samples were taken from each subject for prostate specific antigen (PSA) determination; they underwent a digital rectal examination (DRE), and were subsequently interviewed to obtain demographic and urologic data. Based on the PSA (>4.0 ng/ml) and DRE results, subjects were appointed for transrectal biopsy (TRB). RESULTS: A total of 973 subjects were screened. Prostate biopsy was recommended to 125 men based on PSA values and DRE results, but it was performed in only 55 of them. 15 of these biopsied men were diagnosed with PCa, mostly with Gleason scores > or = 7. CONCLUSION: Our results reflect a low prevalence of PCa in general, but a high occurrence of high grade lesions (Gleason > or = 7) among patients that resulted positive for PCa. This observation remarks the importance of the PCa screening programs in our Mexican community and the need for strict follow-up campaigns.

[Use of alfuzosin for expulsion of stones in the distal third of ureter]. / Uso de alfuzosina para la expulsión de cálculos del tercio distal del uréter.

INTRODUCTION: Ureteral stones occur in approximately 12% of the population worldwide, and their incidence has significantly increased in recent years in Western countries. Seventy percent of ureteral stones are located in the distal third of the ureter. Several factors have a strong influence on spontaneous passage of ureteral stones, including stone size, shape, and location. Alpha blockers are currently attributed a potential role in rapid expulsion of stones in the distal third of the ureter. MATERIALS AND METHODS: Thirty patients diagnosed of stones in the distal third of ureter of sizes ranging from 4 mm and 10 mm were divided into two groups. The first group was given Buscopan 10 mg plus ketorolac 10 mg every 8 hours, while the second group received alfuzosin 10 mg every 24 hours. RESULTS: In group 1, mean stone size was 6.4 mm. Stone expulsion occurred in only 4 patients after a mean of 11.4 days. In group 2, mean stone size was 5.8 mm, and stone expulsion occurred in 13 patients after a mean of 3.3 days.The two stones that were not passed where the biggest ones (9 mm and 10 mm). CONCLUSIONS: Use of alpha-adrenergic blockers for ureteral distal third stones has been shown to be effective for increasing the stone expulsion rate and even the number of stones passed, and for faster symptom relief.

[Liposarcoma of the espermatic cord: our experience and review of the literature]. / Liposarcoma del cordón espermático: nuestra experiencia y revisión de la literatura.

INTRODUCTION: The paratesticular tumors represent 7-10% of the intraescrotales masses. Sarcomas includes 90% of the espermatic cord malignant lessons and approximately the 3-7% are liposarcomas. MATERIAL AND METHODS: We presented our experience with two cases of paratesticular liposarcomas. RESULTS: Actually it has been reported near 161 cases of paratesticular liposarcoma. Due to the rarely of this pathology it is difficult to know its natural history and to reach conclusions of the treatment results, which one until the moment continues being radical orchiectomy with wide local resection of the surrounding soft tissues, the value of adjuvant radiation and chemotherapy is even controversial. CONCLUSIONS: Sarcomas of the espermatic cord are rare, their initial treatment is surgical, we recommended the transoperatory valuation of the surgical edges to try to diminish the recurrence frequency.

[Penile calciphylaxis: 5-year experience and literature review]. / Calcifilaxis de pene: nuestra experiencia en 5 años y revisión de la literatura científica.

INTRODUCTION: Necrosis of the penis is a rare condition that may occur as a result of infectious dissemination, circulatory disorders, or even in patients with penile prostheses. It has been reported in a few patients on dialysis, usually associated with diabetes mellitus, cholesterol embolism, and calciphylaxis. CASE REPORTS: Three patients with this condition seen at our hospital in the last 5 years are reported. CONCLUSIONS: Calciphylaxis is a rare but often fatal condition occurring in approximately 1% of patients with chronic renal failure. It is characterized by calcification of subcutaneous arteries and infarction of the subcutaneous cellular tissue and overlying skin. It is associated to a high morbidity and mortality, and diagnosis is usually based on clinical signs and symptoms. Management is controversial, particularly with regard to surgery, which may range from penectomy to local care of lesion, debridement, or antibiotic therapy.

Fournier's gangrene: our experience in 5 years, bibliographic review and assessment of the Fournier's gangrene severity index.

OBJECTIVES: Fournier's gangrene is a devastating infection, which includes the genital, perineal and/or perianal regions. It is potentially fatal, and affects any age and gender. The severity index for Fournier's gangrene has been described; it is useful for evaluating the prognosis of these patients. Our goal is to report our experience with this disease over the past 5 years and evaluate the index in retrospect. METHODS: We analyzed medical records of patients with Fournier gangrene over the last 5 years at the University Hospital "Dr. José E. González". RESULTS: We reviewed 50 cases, male gender was predominant (96%), mean age 47.5 years, diabetes mellitus was found in 80%, neurogenic bladder in 10%, 2% HIV positive. The most frequent sites of origin of infection were scrotum (52%) and perineum (38%), the most common pathogen E. coli and Enterococcus faecalis (48 and 28% respectively). The death rate was 12%. The average severity index was 5.64. DISCUSSION: In our hospital, Fournier's gangrene is rare. Nevertheless, there is a rapid diagnosis protocol and therapeutic management is performed immediately. Until now, the immediate surgical treatment and early initiation of antibiotic therapy remains the best therapeutic option. CONCLUSION: There is a relationship between the index of severity and patient survival, which may become a useful parameter in evaluating these patients.

[Does circumcision affect male's perception of sexual satisfaction?]. / Genitoplastia feminizante en hiperplasia suprarrenal congénita; una o dos etapas quirúrgicas?

SUMMARY OBJECTIVES: To evaluate the effect of circumcision on sexual satisfaction perception in males with stable sexual partners. METHODS: Twenty two heterosexual male adults, sexually active with a stable partner, scheduled for circumcision for medical (MR) or esthetic reasons (ER) at our clinic between June 2005 and June 2006 were included in this study. Men with severe erectile dysfunction (ED) were excluded from the study. These men were surveyed to assess erectile function, penile sensitivity, esthetical penis' appearance, sexual activity and overall satisfaction before the procedure and 12 weeks after. Categorical scores were evaluated with Chi square. RESULTS: Surgical indications were: Phimosis 50%, balanitis 18.2%, condyloma 13.6% and esthetics 13.6%. After the procedure 82% of patients referred an upgrade on the quality of their sexual intercourse, 4.5% referred it diminished and 13.5% referred no change at all. 95.5% of the patients felt better with the appearance of their penis. Almost all areas of sexual satisfaction weren't statistical significant except for the improvement in erectile function (p 0.0007) and perception of sexual events (p 0.04). This improvement on erectile function was reported as shifts from mild to normal on International Index of Erectile Function 5 scores. Premature ejaculation was observed in 31.8%(7) before the procedure and diminished to 13.6%(3). CONCLUSION: Because of our statistic limitations and mix indications for circumcision in the study, we cannot conclude that circumcision might bring certain benefit on sexual satisfaction by itself but certainly does not bring deleterious effects and, when dissatisfaction is associated with local problems, some benefit could be expected.