Resección de tumor de Buschke-Löwenstein en una mujer embarazada: reporte de un caso y revisión de la bibliografía / Buschke-Löwenstein tumor resection in a pregnant women: A case report and literature review

Resumen INTRODUCCIÓN: El tumor de Buschke-Löwenstein se asocia con el virus del papiloma humano por lo que se considera una infección de transmisión sexual. Se caracteriza por un condiloma gigante, verrugoso, exofítico, con forma de coliflor, de crecimiento lento, pero que durante el embarazo puede crecer rápidamente y formar condilomas solitarios que afectan las estructuras vecinas. CASO CLÍNICO: Paciente de 18 años, primigesta, con 35 semanas de embarazo, sin antecedentes de importancia para el padecimiento actual. Cuatro meses previos inició con verrugas en el perineo, con aumento acelerado de su tamaño en los últimos 30 días, asociado con dolor intenso a la movilización, secreción fétida, eritema e irritación interglútea y formación de un tumor friable con tendencia al sangrado y áreas de necrosis. CONCLUSIONES: El tumor de Buschke-Löwenstein es una alteración poco frecuente causada por el virus del papiloma humano, que puede tener crecimiento acelerado por el estímulo hormonal, propio del estado gestacional. El tratamiento de primera línea es la resección quirúrgica. El seguimiento de las pacientes debe ser estrecho, debido al alto índice de recidiva.

Abstract BACKGROUND: Buschke-Löwenstein tumor is associatted with the human papillomavirus (HPV), which is considered a sexually transmitted infection, characterized by the presence of a giant wart, exophytic condyloma with the shape of a cauliflower, slow growth, but during pregnancy it can grow fast as a solitary condyloma, affecting other structures. This case provides a better understanding of an unusual pathology, which with surgical treatment was obtained aesthetic results and with adequate functionality of external genitalia. CLINICAL CASE 18-year-old female, primiparous with 35 weeks pregnant, with no significant history, 4 previous months begins with the presence of warts in the perineal region with accelerated increase in size in the last 30 days, associated with intense pain on mobilization, fetid discharge, and area oferythema and intergluteal irritation, friable tumor with a tendency to bleed with areas of necrosis. CONCLUSIONS: The Buschke-Löwenstein tumor is a rare pathology caused by HPV, which can present accelerated growth due to the hormonal stimulus of the gestational state, this tumor does not resolve spontaneously, so the surgical approach is considered top of the line. The follow-up of these patients must be close due to the high rate of recurrence.

Trauma Type and Posttraumatic Stress Disorder as Predictors of Parenting Stress in Trauma-Exposed Mothers.

Trauma exposure is associated with various parenting difficulties, but few studies have examined relationships between trauma, posttraumatic stress disorder (PTSD), and parenting stress. Parenting stress is an important facet of parenting and mediates the relationship between parental trauma exposure and negative child outcomes (Owen, Thompson, & Kaslow, 2006). We examined trauma type (child maltreatment, intimate partner violence, community violence, and non-interpersonal traumas) and PTSD symptoms as predictors of parenting stress in a sample of 52 trauma-exposed mothers. Community violence exposure and PTSD symptom severity accounted for significant variance in parenting stress. Further analyses revealed that emotional numbing was the only PTSD symptom cluster accounting for variance in parenting stress scores. Results highlight the importance of addressing community violence exposure and emotion regulation difficulties with trauma-exposed mothers.

Maternal PTSD and Children's Adjustment: Parenting Stress and Emotional Availability as Proposed Mediators.

OBJECTIVES: Maternal posttraumatic stress disorder (PTSD) is a risk factor for negative child adjustment, but it is unclear whether this association is direct (e.g., a mother's PTSD symptoms are observed, learned, and internalized by children which results in behavioral and emotional problems) or indirect, through parent-child relationship difficulties or parenting stress. We hypothesized that parenting stress and maternal emotional availability would exhibit indirect effects on relationships between maternal PTSD and children's functioning. METHOD: Participants were 52 trauma-exposed mothers and their children (aged 7-12 years). Mothers completed measures of PTSD and parenting stress and reported on their children's functioning. Emotional availability was assessed through observer-rated mother-child interactions. RESULTS: Emotional availability was not related to PTSD or child outcomes. Parenting stress had a substantial indirect effect on the relationships between maternal PTSD and child emotion regulation, internalizing, and externalizing behaviors. CONCLUSIONS: Results highlight the need to target parenting stress in interventions with trauma-exposed families.

Frightened versus not frightened disorganized infant attachment: Newborn characteristics and maternal caregiving.

The disorganized infant has been described as experiencing "fright without solution" (Hesse & Main, 1999, p. 484) within the attachment relationship. Using a sample at risk because of poverty (n = 157), this study evaluated the role of newborn characteristics in predicting disorganized attachment and explored the existence of 2 subgroups of disorganized infants, based on whether they display direct indices of fear. For the entire sample, regression analyses revealed that newborn characteristics did not predict ratings of disorganization directly or via moderation by caregiving. Regarding subgroups, it was hypothesized that, if direct expressions of fear resulted from interaction with a frightening or frightened caregiver, it could be expected that infants in the Not Frightened subgroup would become disorganized in part because of other factors, such as compromised regulatory abilities at birth. Results supported this hypothesis for emotional regulation, but not for orientation; infants in the Not Frightened subgroup displayed limited emotional regulation as newborns. Findings suggest that the disorganized attachment category may be comprised of 2 subgroups, with direct expressions of fear as the key differentiating factor. Specifically, disorganized infants who do not display direct fear in the presence of the caregiver may have started out with compromised emotional regulation abilities at birth.

Angels in the nursery: The intergenerational transmission of benevolent parental influences.

Fraiberg and her colleagues (1975) introduced the metaphor "ghosts in the nursery" to describe the ways in which parents, by reenacting with their small children scenes from the parents' own unremembered early relational experiences of helplessness and fear, transmit child maltreatment from one generation to the next. In this article we propose that angels in the nursery-care-receiving experiences characterized by intense shared affect between parent and child in which the child feels nearly perfectly understood, accepted, and loved-provide the child with a core sense of security and self-worth that can be drawn upon when the child becomes a parent to interrupt the cycle of maltreatment. We argue that uncovering angels as growth-promoting forces in the lives of traumatized parents is as vital to the work of psychotherapy as is the interpretation and exorcizing of ghosts. Using clinical case material, we demonstrate the ways in which early benevolent experiences with caregivers can protect against even overwhelming trauma, and examine the reemergence of these benevolent figures in consciousness as an instrument of therapeutic change. Finally, we examine implications of the concept of "angels in the nursery" for research and clinical intervention.

Earned-secure attachment status in retrospect and prospect.

Past research with the Berkeley Adult Attachment Interview demonstrates that retrospectively defined earned-secures (who coherently describe negative childhood experiences) parent as effectively as do continuous-secures (who coherently describe positive childhood experiences), but manifest liabilities in the form of depressive symptomatology. This article presents data from a 23-year longitudinal study that replicate and extend prior research, testing a key premise that earned-secures so defined actually have a history of insecure attachments that change over time and/or endure consistently harsh or ineffective parenting in their youth. Discrepant with assumptions, retrospective earned-secures were not more likely than continuous-secures to have been anxiously attached in infancy and were observed in childhood and adolescence to have encountered among the most supportive and structured maternal parenting in a high-risk sample. Prospectively defined earned-secures (operationalized using participants' infant attachment classifications) did indeed go on to have success in their close relationships, many without reporting relatively high levels of internalizing distress in adulthood.