Donovanosis: reporte de caso / Donovanosis: report of a case

La Donovanosis es una enfermedad ulcerativa crónica y progresiva que ataca por lo común la región genital, es producida por el Calymmatobacterium granulomatis, bacteria Gram negativa. La Azitromicina ha emergido como la droga de elección para su tratamiento. Se presenta un caso de Donovanosis en un varón de 46 años, quien tenía relaciones heterosexual y homosexual, el cuál presento papula anal que evoluciono a una úlcera crónica, le realizan el diagnostico de tumoración anorrectal a descartar una neoplasia anorrectal y le realizan colostomía. El retardo en la sospecha clínica en un área no endémica concluyo con su diagnóstico con un extendido en lámina para microscopia con coloración Giemsa.

Donovanosis is a chronic and progressive ulcerative disease that frequently attacks the genital region. It is produced by the gram negative bacteria Calymmatobacterium granulomatis. Azythromycin has emerged as the drug of choice for its treatment. We present one DonovanosisÆ case in a 46-year-old male, who had heterosexual and homosexual intercourse. He presented anal papulae that evolved to a chronic ulcer. He was diagnosed as having an anal and rectal tumor, and colostomy was performed to discard neoplasia. Delay in clinical diagnosis in a non endemic area concluded with diagnosis by Giemsa stain of a sample and microscopic observation.

Manejo no operatorio del trauma abdominal cerrado en el Hospital Puente Piedra / Nonsurgical handing of closed abdominal trauma at the Hospital Puente Piedra

El manejo del traumatismo abdominal cerrado, es sin duda una noxa de peculiar accionar, ante su sospecha, como una emergencia potencial de riesgo de vida. Las diferentes escuelas de cirugía, con el transcurso de los años, empiezan a cuestionarse acerca del manejo de esta patología, sea por cirugía abierta, o manejo no quirúrgico. A la actualidad existen protocolos y mayores criterios que acercan con más sensibilidad y especificidad, para decidir entre alguna alternativa. Presentamos el reporte de un caso de una mujer adulta, que sufre impacto abdominal, por una mototaxi, vehículo de transporte usual en la comunidad de Puente Piedra (Lima-Perú). Evaluada en el Hospital Puente Piedra, refiriendo como síntoma y signo principal, dolor abdominal en hipocondrio izquierdo, además hemodinamicamente estable, y con hematocrito de ingreso de 22%. Se le catalogo como traumatismo abdominal cerrado, con sospecha de ruptura esplénica, esta fue confirmada por ecografía y tomografía computada abdominal, manejándosele de forma no quirúrgica.

Handling of closed abdominal trauma is a noxa with a peculiar way of action when suspected, because of its life threatening potential. Different Schools of Surgery, as years go by, start to question how to handle this pathology, either by open surgery or non surgical procedures. Today, there are protocols and criteria with better sensitivity and specificity that approach this issue to decide among alternatives. We present the report of an adult woman that suffered abdominal trauma by an auto rickshaw (a common way of transportation in the Puente Piedra area). She was evaluated at the Hospital de Puente Piedra, referring as symptoms and main signs abdominal pain at left upper quadrant. She was hemodinamically stable, and had a 22% hematocrit level when admitted. Diagnosis was established as closed abdominal trauma with possible splenic rupture that was confirmed by tomography and ecography. Handling of the patient was non- surgical.

Menopausia: qué conocen las mujeres / Menopause: what do women know

Se encuestó un total de 109 mujeres mayores de 40 años, quienes definieron a la menopausia en un 44% como un proceso natural y en un 40% como el cese de la menstruación. El 74 % de las encuestadas precisó que la menopausia era de causa natural y un 55% que afectó su vida sexual; asimismo un 40% refirió dolor al tener relaciones sexuales, un 57% que el deseo sexual disminuyó y un 12 % aumentado. En lo referente a los cambios en el estado de ánimo manifestaron tristeza en un 37%. El 88% de las encuestadas refirió haber presentado por lo menos un síntoma. La distribución de los síntomas en orden de frecuencia de los que manifestaron tener al menos uno de ellos, son: Bochornos 25%, Tristeza 17%, Soledad 15%, Insomnio 13% , Irritabilidad 13%, Dolor al tener relaciones sexuales 9%, Temblor 7%, Intento de suicidio 1%. El 45% refiere haber generado un cambio en su forma de vida y el 70% de la población estudiada no había recibido ningún tipo de información; un 86% de las encuestadas desearían recibir información y un 48% con una frecuencia de por lo menos una vez al mes.

The aim of this research was to determine knowledge about menopause in patients that go to the clinical practice at the Hospital de Puente Piedra, located 35 Km north of Lima, and whose population is mainly of a marginal urban area. A clinical interview was performed in 109 women over 40 between March-August 2005 that went to medical consultations to the different areas of the Hospital, asking them about their knowledge on menopause. Forty four percent of them considered menopause as a natural process and 40% considered menopause as the cessation of menstrual cycles. Seventy four percent of interviewed established menopause as a natural cause and 55% that it affected their sexual life. Also, 40% referred having pain at the moment of sexual intercourse, 57% that their sexual desire diminished and 12% that it increased. Related to mood changes, 37% manifested being sad, 88% referred presenting at least one symptom. Distribution of symptoms according to their frequency (admitting having at least one of them); hot flashes (25%), sadness (17%), loneliness (15%), insomnia (13%), irritability (13%), pain at sexual intercourse (9%), tremors (7%), suicidal attempts (1%). Forty five percent refers changes in their lifestyle and 70% of the population studied had not received any type of information, 86% of interviewed would like to receive information and 48% would like to receive information with a frequency of at least once a month. The population studied accepts menopause as menstrual cycle cessation and as a natural process, recognizes symptoms with changes in their lifestyle and have no IEC about this matter.