RESUMEN
OBJECTIVE: To describe vulvoperineal reconstruction with a flap of the sulcus gluteus. STUDY DESIGN: Nonrandomized, prospective study in patients with vulvar cancer and vulvar intraepithelial neoplasia. After oncologic surgery, reconstruction with a sulcus gluteus flap was performed. The flap is supplied by the internal pudendal artery, and innervation is provided by the pudendal nerve. The tuber ischiale is the anatomic landmark for locating the pedicle. Follow-up was from 2 months to 2 years. Immediate and long-term complications were assessed. Aesthetic and functional results were analyzed and related to the quality of life and length of hospitalization. RESULTS: Vulvoperineal reconstruction was carried out in 6 patients who had undergone radical surgery. For reconstruction we used the sulcus gluteus flap in 4 unilateral cases and in 2 bilateral cases, for a total of 8 flaps. Cutaneous flaps of the sulcus gluteus provided good functional and aesthetic results. All flaps survived. There was no flap necrosis. The average length of hospitalization was 4 days. Complications were 2 breakdowns of the wound and 1 lymphocele. Postoperative discomfort was minimum. Patients were allowed to walk on day 6 and to sit on day 15. CONCLUSION: The advantages of this reconstruction are that it: is useful in cases of lymphadenectomy, is sensitive and maintains innervation, is distant enough from the receptor area to be used for large vulvar lesions, is able to hide the scar from the donor area in the sulcus gluteus, has a low complication rate, has a short hospitalization time and provides very good compliance with follow-up.
Asunto(s)
Carcinoma/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Neoplasias de la Vulva/cirugía , Adulto , Anciano , Nalgas , Carcinoma/patología , Femenino , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Persona de Mediana Edad , Perineo/cirugía , Estudios Prospectivos , Medición de Riesgo , Muestreo , Resultado del Tratamiento , Neoplasias de la Vulva/patologíaRESUMEN
To our knowledge, no studies have previously been carried out on the heterogeneity and intrafamily colonization of impetigo Staphylococcus aureus strains obtained by powerful discriminating methods such as pulsed-field gel electrophoresis (PFGE). To explore this topic, macrorestriction patterns of S. aureus strains were analyzed after SmaI and SgrAI digestion. The two enzymes provided superimposable results. A total of ninety-seven S. aureus strains was found in the 26 families whose lesions and nasal and pharyngeal samples were examined. There were 39 strains which were different by PFGE, and of these, 24 were found in the lesions. Although 85% of impetigo patients showed nasal colonization and 58% showed pharyngeal colonization, only 54% of the patients had the same PFGE strain in the lesion and in the nose, and 35% in the lesion and the pharynx. In half of the 26 families, at least one member (mother, father, or relative) presented a S. aureus strain identical, by PFGE, to strains isolated in patients' lesions. Nineteen percent of mothers, 15% of fathers, and 19% of the other relatives presented nasal colonization with strains identical to those isolated in the children's lesions. Lesional strains showed higher antimicrobial resistance than nonlesional isolates.
Asunto(s)
ADN Bacteriano/análisis , Variación Genética , Impétigo/microbiología , Staphylococcus aureus/genética , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , ADN-Citosina Metilasas , Desoxirribonucleasas de Localización Especificada Tipo II , Electroforesis en Gel de Campo Pulsado , Femenino , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Nariz/microbiología , Faringe/microbiología , Mapeo Restrictivo , Staphylococcus aureus/clasificación , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Staphylococcus aureus strains generally colonize eczematous lesions of subjects with atopic dermatitis much more frequently than in the skin of normal individuals. The aim of this study was to provide a detailed genotypic and phenotypic analysis of S. aureus strains colonizing four different sites (lesional and non-lesional skin areas, nasal and pharyngeal mucosas) of 49 patients with atopic dermatitis. The 88 isolates were analyzed in duplicate by pulsed field gel electrophoresis and in their exfoliative toxin A or B production by latex test. The patients were characterized by age, sex, severity scoring of atopic dermatitis and serum eosinophil cationic protein. Fourteen (28.6%) of the patients were completely negative for S. aureus while 35 (71.4%) were positive in at least one site. The severity scores and eosinophil cationic protein levels were significantly correlated variables (P<0.001), linked to the colonization intensity (P ranging between 0.05 and <0.001 depending on the site) and to the number of colonized sites (P at least <0.01). The genotypic patterns, widely heterogeneous, showed no restriction to peculiar patterns. Only eight strains produced exfoliative toxin B which was significantly restricted to the lesional isolates (P=0.012).
Asunto(s)
Dermatitis Atópica/microbiología , Ribonucleasas , Staphylococcus aureus/genética , Staphylococcus aureus/patogenicidad , Adolescente , Adulto , Proteínas Sanguíneas/metabolismo , Niño , Preescolar , Recuento de Colonia Microbiana , Dermatitis Atópica/sangre , Electroforesis en Gel de Campo Pulsado , Proteínas en los Gránulos del Eosinófilo , Exfoliatinas/biosíntesis , Femenino , Genotipo , Humanos , Lactante , Masculino , Persona de Mediana Edad , Fenotipo , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Opportunist infections involving Candida albicans often develop in HIV-positive patients and oral lesions tend to become more frequent as the disease progresses. Previous studies have shown contrasting results concerning the variability of the pulsed-field gel electrophoresis (PFGE) subtypes of C. albicans observed in HIV-positive patients. Carriage of C. albicans was determined by an oral rinse technique; 41 strains of C. albicans (78% serotype A and 22% serotype B) were isolated. There was a direct correlation between candidal load (cfu/ml) and the blood HIV load, whereas there was an inverse correlation with the stage of disease and the CD4 cell counts. The PFGE patterns of isolates were variable with regard to the number and positions of bands. The variability of the band sizes in some run positions showed a Gaussian distribution. Generally, the most frequent size variants were associated with the strains with the highest cfu/ml and lowest CD4 counts (< or =200 cells/microl). These findings suggest a possible strain selection over time during disease progression, especially in HIV-positive subjects with low CD4 counts.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Candida albicans/clasificación , Candidiasis Bucal/microbiología , Portador Sano/microbiología , Infecciones por VIH/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Adulto , Recuento de Linfocito CD4 , Candida albicans/genética , Candidiasis Bucal/inmunología , Portador Sano/inmunología , ADN Viral/química , Progresión de la Enfermedad , Electroforesis en Gel de Campo Pulsado/métodos , Femenino , Infecciones por VIH/inmunología , Infecciones por VIH/virología , Humanos , Cariotipificación , Masculino , Persona de Mediana Edad , Boca/microbiología , Serotipificación , Carga ViralRESUMEN
A woman with stage I squamous carcinoma of the vulva associated with diffuse lichen sclerosus was treated with radical vulvectomy plus inguinofemoral and pelvic lymphadenectomy. This procedure was followed by vulvar reconstruction using bilateral gracilis myocutaneous grafts. Two years later the previously normal grafted skin had developed lichen sclerosus. This occurrence is unique and completely unexpected in view of the graft technique, which preserves the original blood supply and deep dermal tissues.
Asunto(s)
Carcinoma de Células Escamosas/patología , Recurrencia Local de Neoplasia , Neoplasias de la Vulva/patología , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Persona de Mediana Edad , Trasplante de Piel , Neoplasias de la Vulva/cirugíaRESUMEN
The slides of 64 vulvectomy specimens from vulvar squamous carcinoma were reviewed in order to study the histopathologic changes adjacent to the neoplasia. Normal epithelium was found in 7 cases (11%) and epithelial alterations adjacent to carcinoma in 59 (89%). The epithelial alterations found were: nonneoplastic epithelial disorder (NNDV) in 38 cases (59%) and vulvar intraepithelial neoplasia (VIN) in 19 (30%). The distribution of NNDV was: 20 cases of epithelial hyperplasia (EH) (31%), 6 of lichen sclerosus (9%) and 12 of the mixed type (19%). Sixteen cases of VIN 3 (25%) were undifferentiated, and three cases were differentiated VIN. Eighteen of 19 VIN cases were associated with NNDV, and 8 cases of undifferentiated VIN were associated with human papillomavirus infection. There was no apparent relationship between the associated lesions and tumor size, depth of invasion, lymph node metastases and clinical stage. Nevertheless, we found a significantly higher frequency of associated lesions in poorly differentiated tumors (P > .01). The most important finding was a high association between EH (50%) and VIN (30%) with carcinoma. VIN cases were almost always (95%) associated with EH.
Asunto(s)
Carcinoma de Células Escamosas/patología , Liquen Escleroso y Atrófico/patología , Papillomaviridae , Infecciones por Papillomavirus/patología , Lesiones Precancerosas/patología , Infecciones Tumorales por Virus/patología , Vulva/patología , Enfermedades de la Vulva/patología , Neoplasias de la Vulva/patología , Biopsia , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Hiperplasia , Incidencia , Liquen Escleroso y Atrófico/epidemiología , Liquen Escleroso y Atrófico/cirugía , Índice Mitótico , Invasividad Neoplásica , Estadificación de Neoplasias , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/cirugía , Lesiones Precancerosas/epidemiología , Lesiones Precancerosas/cirugía , Infecciones Tumorales por Virus/epidemiología , Infecciones Tumorales por Virus/cirugía , Enfermedades de la Vulva/epidemiología , Enfermedades de la Vulva/cirugía , Neoplasias de la Vulva/epidemiología , Neoplasias de la Vulva/cirugíaRESUMEN
Syringoma of the vulva, especially as the multiple form, is a rare disorder. A review of the diagnoses in 4,500 patients from the Vulvar Clinic, Hospital de Clínicas José de San Martín, First Chair of Gynecology, Buenos Aires University, revealed only three cases, two of which were asymptomatic. The third patient, with multiple lesions and severe discomfort, is presented. With cryotherapy the lesions healed, and the patient was asymptomatic even during warm weather.
Asunto(s)
Siringoma/patología , Neoplasias de la Vulva/patología , Crioterapia , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Siringoma/terapia , Resultado del Tratamiento , Neoplasias de la Vulva/terapiaRESUMEN
In 59 cases of vulvar invasive squamous cell carcinoma treated with radical vulvectomy and inguino-femoral lymphadenectomy, seven histologic parameters were evaluated to establish their predictive value in the development of lymph node metastasis. The most significant was vascular involvement, observed in 86% of cases with lymph node metastases (P < .000004). Depth of stromal invasion and tumor thickness were highly significant, with P < .008 and < .007, respectively, with 0% lymph node metastases in tumors thinner than 1 mm and 62% and 60%, respectively, in those thicker than 5 mm. The growth pattern correlated with lymph node metastases but was not statistically significant. The histologic grade correlated with positive lymph nodes, with P < .04. The amount of keratin (P < .91) was not related. These histologic factors allow the identification of patients with a lower risk of developing lymph node metastases and in whom conservative surgery on the vulva and inguino-femoral lymph nodes is feasible.
Asunto(s)
Carcinoma de Células Escamosas/patología , Neoplasias de la Vulva/patología , Adulto , Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Invasividad Neoplásica , Pronóstico , Factores de Riesgo , Neoplasias de la Vulva/cirugíaRESUMEN
Contrasting data are reported in the literature on the percent positivity rates (13.5%-100%) of exfoliative toxin (ET) production by S. aureus strains isolated from impetigo patients in Japan and in France. In the present study, by means of a recently available latex-test, toxin-A (ETA) or toxin-B (ETB) production was found in 67.6% of the 34 S. aureus strains isolated from 19 lesional (63.2%) and 15 non-lesional (nose or pharynx, 73.3%) areas of patients with impetigo (with no significant difference between the lesional and non-lesional isolates). ETA + ETB were produced by 44.1% of the strains, while 32.4% were non-producers. In contrast, the percent positivity rate observed in 40 [20 lesional and 20 non-lesional (nose or pharynx)] strains isolated in patients with atopic dermatitis was 15.0% (p < 0.001 both for the lesional and non-lesional strains versus impetigo, with no significant difference between lesional and non lesional strains). Finally, 26 strains from other types of specimens (abscesses, hemocultures, urine, central venous catheters, bronchoalveolar lavages) showed an 11.5% production rate of ETA or ETB (p < 0.001 versus impetigo strains, no significance versus atopic dermatitis). These data point to a significant association between exfoliative toxin production and S. aureus strains isolated in impetigo, both in lesional areas and in nasal/pharyngeal reservoirs. An attempt to correlate SmaI pulsed-field gel electrophoresis (PFGE) restriction patterns and exfoliative toxin production showed no significant association in either group.
Asunto(s)
Desoxirribonucleasas de Localización Especificada Tipo II/metabolismo , Electroforesis en Gel de Campo Pulsado , Exfoliatinas/metabolismo , Impétigo/microbiología , Staphylococcus aureus/clasificación , Adolescente , Adulto , Anciano , Técnicas de Tipificación Bacteriana , Niño , Preescolar , Dermatitis Atópica/microbiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Nariz/microbiología , Faringe/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Staphylococcus aureus/metabolismoRESUMEN
PFGE has been extensively used to obtain a reliable intra-species differentiation, although this technique has not been completely standardized. In this study, PFGE was applied to analyze in detail the patterns of 19 lesional S. aureus strains isolated from patients with impetigo, compared with 15 non-lesional strains isolated from nasal or pharyngeal swabs of the same patients. The strain DNA was extracted and processed as previously reported, using the strictest protocol to limit the variations between different analytical sets. To obtain maximum sensitivity and comparability, the electrophoresis patterns were analyzed by an automated and computerized reader (GelDoc1000). The DNA fragments (range 12-15 bands) obtained for each individual strain were then divided into 39 zones including from 1 to 4 bands for a total of at least 91 possible different gel positions. The positivity for each zone (and/or the positivity for the individual bands contained) was associated with the lesional/non-lesional origin and with the face localization of the strains.
Asunto(s)
Electroforesis en Gel de Campo Pulsado , Impétigo/microbiología , Nariz/microbiología , Faringe/microbiología , Staphylococcus aureus/clasificación , ADN Bacteriano/análisis , Humanos , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificaciónAsunto(s)
Homosexualidad , Neisseria meningitidis/aislamiento & purificación , Antibacterianos/farmacología , Portador Sano/microbiología , Gonorrea/microbiología , Humanos , Masculino , Neisseria meningitidis/efectos de los fármacos , Faringe/microbiología , Ciudad de Roma , Uretritis/microbiologíaRESUMEN
We examined the dust collected from the floors of forty classrooms, twenty in kindergarten schools (children aged 2-5) and twenty in secondary schools (students aged 11-14) in order to determine the diffusion of keratinophilic fungi in respect to such different factors as human presence and children's age. In the kindergarten schools 268 colonies of keratinophilic fungi were isolated: 50 were Microsporum, 6 Trichophyton and 212 Chrysosporium species. Members of the Chrysosporium genus were found the widely diffused. It is interesting to note the isolation of M. gypseum in two schools. In the secondary schools 847 colonies of keratinophilic fungi were isolated: 727 were Chrysosporium, 81 Microsporum, 38 Trichophyton and 1 Epidermophyton species. Again the Chrysosporium species were the most widely diffused. It is remarkable to point out the isolation of pathogenic species such as Epidermophyton floccosum, Microsporum canis, Microsporum gypseum and the rather rare Microsporum vanbreuseghemii.
Asunto(s)
Microbiología Ambiental , Hongos/aislamiento & purificación , Instituciones Académicas , Adolescente , Niño , Preescolar , Chrysosporium/aislamiento & purificación , Polvo , Epidermophyton/aislamiento & purificación , Humanos , Microsporum/aislamiento & purificación , Ciudad de Roma , Escuelas de Párvulos , Trichophyton/aislamiento & purificaciónRESUMEN
This case reports on a vulvar lichen sclerosus, followed during 11 years, with poor response to many different local and general treatments. After 6 years of control the patient developed a mild atypia. Two years later, an invasive carcinoma was diagnosed and radically treated. Six months later, a local recurrence was excised. During the last year of control new biopsies of the neovulva showed, at different times, carcinoma in situ and severe atypia.