Angiomiolipoma nasal: reporte de dos casos y revisión de la literatura

Resumen El angiomiolipoma es una lesión hamartomatosa, habitualmente de localización renal asociado a esclerosis tuberosa. La ubicación nasosinusal es extremadamente infrecuente y se puede presentar con obstrucción nasal y epistaxis. Se presentan dos casos de angiomiolipoma de cavidad nasal diagnosticados en el Hospital Carlos Van Buren de Valparaíso. Ambos casos se presentaron como masa nasal unilateral, se estudiaron con tomografía computada y fueron tratados con biopsia escisional, sin presentar recidivas durante su seguimiento. El anigiomiolipoma está compuesto por vasos sanguíneos, músculo liso y adipocitos. Existen diferencias entre el angiomiolipoma del riñón versus el de piel, cavidad oral y nasal (angiomiolipomas mucocutáneos); estos últimos son extremadamente infrecuentes, de menor tamaño, con presencia de agregados linfoides, negativos para antígeno específico de melanoma HMB-45 y sin asociación a esclerosis tuberosa. Existen pocos casos reportados en la literatura de esta patología, por lo que existe poca evidencia. Clínicamente, se presentan con obstrucción nasal, epistaxis recurrente, sensación de masa nasal. El estudio preoperatorio depende de su extensión y puede incluir una tomografía computada y/o angiografía para identificar su irrigación. El diagnóstico definitivo es anatomopatológico. Si se logra la escisión completa, no se han reportado recidivas, por lo que presenta un excelente pronóstico.

Abstract Angiomyolipoma is a hamartomatous lesion, usually of a renal location associated with tuberous sclerosis. Nasosinusal location is extremely rare and can present with nasal obstruction and epistaxis. Two cases of angiomyolipoma of the nasal cavity diagnosed at the Carlos Van Buren Hospital in Valparaíso are presented. Both cases presented as a unilateral nasal mass, and were studied with computed tomography, and treated with an excisional biopsy, with no recurrences during follow-up. Anigiomyolipoma is composed of blood vessels, smooth muscle and adipocytes. There are differences between angiomyolipoma of the kidney versus skin, oral and nasal cavity (mucocutaneous angiomyolipomas). The latter are extremely infrequent, smaller in size, with the presence of lymphoid aggregates, negative for the HMB-45 specific melanoma antigen and without association with tuberous sclerosis. There are few cases reported in the literature of this pathology, so there is little evidence. Clinically, they present with nasal obstruction, recurrent epistaxis, sensation of nasal mass. The preoperative study depends on its extension and may include a computed tomography and/or angiography to identify its irrigation. The definitive diagnosis is pathological. If complete excision is achieved, no recurrences have been reported, so it has an excellent prognosis.

Análisis de supervivencia de carcinoma escamoso de laringe en una cohorte retrospectiva chilena del Hospital Carlos Van Buren de Valparaíso / Survival analysis of laryngeal squamous cell carcinoma in a chilean retrospective cohort at the Carlos Van Buren Hospital of Valparaíso

Resumen Introducción: El cáncer laríngeo es una de las neoplasias de cabeza y cuello más frecuentes, asociado al envejecimiento y a los hábitos de vida. Los análisis de supervivencia de cáncer laríngeo en Chile son escasos. Objetivo: Calcular y analizar la supervivencia y las características clínicas del cáncer laríngeo en pacientes del Servicio de Otorrinolaringología del Hospital Carlos Van Buren, Valparaíso, Chile. Material y Método: Se realizó un estudio retrospectivo de cohorte, incluyendo pacientes diagnosticados con carcinoma escamoso de laringe entre 2007 y 2018. Se calculó la supervivencia con el método de Kaplan-Meier. Se aplicaron las pruebas de log rank, t de Student y exacta de Fisher. Resultados: Se incluyeron 211 pacientes, 90,52% hombres, con un promedio de edad de 68 años. El factor de riesgo más frecuente fue el tabaquismo. La ubicación tumoral más frecuente fue la glotis (59,44%) y el motivo de consulta más común la disfonía (52,66%). Un 70,48% presentó estadios avanzados. En 23,92% se realizó laringectomía total como tratamiento primario. La supervivencia global a 2 años fue de 86,6% en estadio precoz y 45,2% en estadio avanzado, mientras que a 5 años fue de 77,4% y 33%, respectivamente. Conclusión: La supervivencia estimada fue menor que en otros estudios nacionales, lo que puede asociarse al tamaño de la muestra analizada, a factores etarios y/o a mayor latencia de inicio de tratamiento. Se enfatiza el mejoramiento de los registros clínicos y la gestión sanitaria para un manejo oportuno.

Abstract Introduction: Laryngeal carcinoma is one of the most frequent head and neck neoplasms, being associated with ageing and lifestyles. In Chile, survival analyses of laryngeal carcinoma are scarce. Aim: To estimate and analyze the survival and clinical characteristics of laryngeal carcinoma in patients attended at the Otorhinolaryngology Department of the Carlos Van Buren Hospital, Valparaíso, Chile. Material and Method: We conducted a retrospective cohort study, including patients diagnosed with laryngeal squamous cell carcinoma between 2007 and 2018. Kaplan-Meier estimator was applied for survival analysis. Log rank test, Student's t-test and Fisher's exact test were applied. Results: 211 patients were included, 90,52% were men, with an average age of 68 years. The main risk factor was smoking (80%). The most frequent tumor location was in the glottis (59,44%) and the most frequent reason for consultation was dysphonia (52,66%). Most cases (70,48%) presented at advanced stages. Laryngectomy was performed as a primary treatment in 23,92%. The 2-year overall survival rate was 86,6% for early stages and 45,2% for advanced stages; the 5-year overall survival rate was 77,4% and 33%, respectively. Conclusion: The estimated survival rate was lower than those referred by other national studies, which may be associated with the analyzed sample size, age-related factors and/or period of latency until the beginning of treatment. We emphasize the necessity of an improvement in clinical records and the health management to the timely treatment.

Estudio comparativo de laringes humanas y de cerdos: hacia un modelo de entrenamiento quirúrgico / Comparative study of human and pig larynxes: towards a surgical training model

Introducción: La laringe de cerdo doméstico tiene similitudes con la laringe humana. La capacidad elástica de las cuerdas vocales del cerdo demuestran tener la mayor similitud con la humana comparado con otros animales por lo que se ha propuesto usar las laringes de cerdo como modelo de entrenamiento quirúrgico. Objetivo: Determinar las diferencias y similitudes anatómicas e histológicas entre la laringe del cerdo y la humana. Material y método: Se realizaron mediciones por 4 observadores en 5 laringes porcinas cuyos resultados se compararon con los descritos en la literatura para las laringes humanas. Además se realizaron cortes histológicos para visualizar fibras elásticas, mucinas neutras y mucinas ácidas. Resultados: El cartílago tiroides porcino mide entre las astas superiores 37,55 ±7,30 mm, entre astas inferiores 31,33 ±3,27 mm, desde la prominencia laríngea al borde posterior 34,32 ±7,30 mm. En el cartílago cricoides, desde el borde superior-inferior en el arco anterior 7,28 ±2,21 mm, altura borde superior-inferior pared posterior 27,47 ±3,40 mm, ancho máximo pared posterior 30,99 ±4,51 mm, diámetro interior anteroposterior (borde cefálico) 30,90 ±2,12 mm, diámetro interior anteroposterior (borde caudal) 21,78 ±2,55 mm, diámetro interior derecha-izquierda (borde cefálico) 18,11 ±2,13 mm, diámetro interior derecha-izquierda (borde caudal) 21,10 ±2,40 mm. Histológicamente, la laringe de cerdo y humana presentan leves diferencias en cuanto al epitelio de cada porción de la laringe, a pesar de que el tipo de cartílago es el mismo en ambas especies. Conclusión: Si bien existen diferencias anatómicas e histológicas entre la laringe de cerdo y el humano, el modelo porcino es una alternativa útil, accesible y de bajo costo para el entrenamiento en cirugía laringotraqueal y microcirugía laríngea.

Introduction: The domestic pig larynx has similarities with the human larynx. The elastic capacity of the vocal folds of the pig has the greater similarity with the human one compared with other animals. It has been proposed to use the porcine larynx as a model for surgical training. Aim: To determine the anatomical and histological differences and similarities between the pig larynx and the human larynx. Material and method: Measurements were made by 4 observers in 5 porcine larynxes whose results were compared with those described in the literature. In addition, histological sections were performed to visualize elastic fibers, neutral mucins and acid mucins. Results: The porcine thyroid cartilage measured 37.55 ±7.30 mm between the upper horns, 31.33 ±3.27 mm between lower horns and 34.32 ±7.30 mm from the laryngeal prominence to the posterior margin. In the cricoid cartilage, from the upper-lower edge in the anterior arch 7.28 ±2.21mm, height upper-lower edge posterior wall 27.47 ±3.40 mm, maximum posterior wall width 30.99 ±4.51 mm, anteroposterior inner diameter (head margin) 30.90 ±2.12 mm, inner diameter anteroposterior (caudal edge) 21.78 ±2.55 mm, inner diameter right-left (head edge) 18.11 ±2.13 mm, inner diameter right-left (caudal edge) 21.10 ±2.40 mm. Histologically, the pig and human larynxes present slight differences in the epithelium of each portion of the larynx, despite the fact that type of cartilage is the same in both species. Conclusions: Although there are anatomical and histological differences between the pig larynx and the human larynx, the porcine model is a useful, accessible and low cost alternative for training in laryngotracheal surgery and laryngeal microsurgery.

Sobrevida y factores pronósticos de 13 pacientes con carcinoma espinocelular oral diagnosticados en el CRS Cordillera Oriente, entre los años 2001 - 2015 / Survival and prognostic factors in 13 patients with oral squamous cell carcinoma diagnosed at the CRS Cordillera Oriente, between the years 2001 - 2015

Introducción: El carcinoma espinocelular (CEC) es una neoplasia maligna derivada del epitelio plano estratificado. Hoy en día ha adquirido mayor importancia debido a que es el cáncer oral más frecuente y su sobrevida sobre los 5 años se ha mantenido baja. Objetivo: Generar información que oriente a odontólogos y médicos en la detección y manejo oportuno del CEC oral analizando la sobrevida según características demográficas y clínicas de pacientes con esta enfermedad atendidos en el CRS Cordillera Oriente. Materiales y métodos: Estudio descriptivo, retrospectivo de tipo serie de casos. La muestra correspondió al total de pacientes diagnosticados con CEC oral en el CRS Cordillera Oriente entre enero de 2001 y mayo de 2015. Para el estudio epidemiológico de la muestra se utilizó estadística descriptiva y para el análisis de la sobrevida se utilizó el método de Kaplan Meier. Resultados: La mayor parte de la muestra fueron hombres (8/13) y mayores de 60 años (7/13). La edad promedio fue de 63,6 años. La presentación más común fue la úlcera crónica (6/13) y la localización más frecuente, el labio (4/13). En su mayoría fueron tumores bien diferenciados (9/13), un estado del tumor primario en etapa pT1 o pT2 (7/8) y ausencia de metástasis en nodos regionales (6/9). Se encontró una distribución homogénea respecto a la etapa TNM. La sobrevida general a los 5 años fue de 57,9%. La sobrevida más baja a los 5 años se presentó en pacientes de sexo femenino, menores de 45 años, fumadores, con presentación de masa exofítica, con tumores de menor grado de diferenciación histológica, con un estado del tumor primario avanzado, con presencia de metástasis en nodos regionales y que se encontraban en una etapa TNM avanzada. Conclusiones: La prevalencia de CEC oral en este centro es baja, sin embargo, es de relevancia dado la reducida sobrevida sobre los 5 años. Esto pone de manifiesto la necesidad de un diagnóstico y tratamiento oportunos. La información presentada es de utilidad para la identificación de la población en riesgo de CEC oral, pudiendo ayudar en el desarrollo de programas de tamizaje. El limitado número de casos puede explicar las diferencias observadas respecto a la literatura nacional e internacional lo que genera la necesidad de realizar nuevos estudios.

Introduction: Squamous cell carcinoma (SCC) is a malignant neoplasm derived from stratified squamous epithelium. Today it has become more important because it is the most common oral cancer and its survival over five years has remained low. Aim: Produce information to guide dentist and physicians in the prompt detection and management of oral SCC through the analysis of survival according to demographic and clinical characteristics of patients diagnosed at the CRS Cordillera Oriente. Methods: We perform a descriptive, retrospective study of case series. Patients diagnosed with oral SCC at the CRS Cordillera Oriente, between January 2001 and May 2015 were selected. We used descriptive statistics for the epidemiological study sample and the Kaplan Meier method for the survival analysis. Results: The study population was mainly men gender (8/13) and over 60 years (7/13). The average age was 63,6 years. The most common presentation was chronic ulcer (6/13) and the most common site, the lip (4/13). Most of the sample had a well differentiated tumor (9/13), a primary tumor stage pT1 or pT2 (7/8) and absence of metastases in regional nodes (6/9). A homogeneous distribution with respect to the TNM stage was found. The overall survival at 5years was 57,9%, the lowest rates were in the female gender, group under 45 years, smokers, exophytic mass, poorly differentiated tumor, advanced primary tumor, presence of regional metastases in nodes and advanced TNM stage. Conclusions: The prevalence of oral SCC in this center is low, however, it is relevant given the reduced survival over 5 years. This highlights the need for early diagnosis and treatment. The information presented is useful for identifying population at risk or oral SCC, and may assist in the development of screening programs. The limited number of cases may explain the observed differences regarding the national and international literature wich generates the need for further studies.

Síndrome de nistagmo vertical hacia abajo: reporte de 2 casos y revisión de la literatura / Downbeat nystagmus syndrome: a report of 2 cases and literature review

El síndrome de nistagmo vertical hacia abajo (NVA) es una forma común de nistagmo de fijación adquirido que se presenta con nistagmo persistente con fase rápida en dirección descendente, mareo, oscilopsia y alteraciones de la marcha. Se considera un trastorno vestíbulo-cerebelar debido a un defecto en las células de Purkinje en el flóculo del cerebelo. Las causas reportadas con mayor frecuencia son los trastornos degenerativos cerebelares e isquemia cerebelar, sin embargo, en un gran porcentaje de los pacientes la etiología permanece incierta (forma idiopática). El NVA se puede dar en un contexto más amplio de neuropatía somatosensorial y ataxia cerebelar en el síndrome CANVAS. Las medidas terapéuticas incluyen evitar la posición supina y prona al descansar, rehabilitación vestibular y tratamiento farmacológico con aminopiridinas, entre otros. En este artículo presentamos dos casos de NVA así como la revisión de la literatura.

Downbeat nystagmus syndrome (DBN) is a frequent form of acquired fixation nystagmus, it presents with persisting nistagmus with fast phases directed downward, dizziness, oscillopsia and gait disturbances. It is considered a vestibulocerebellar disorder due to a bilateral defect of the Purkinje cells in the cerebellar flocculus. Most reported causes are degenerative disorders of the cerebellum and cerebellar ischemia, nevertheless the etiology remains unknown in a large percentage of patients (idiopathic form). DBN may present in a broader context of somatosensory neuropathy and cerebellar ataxia as in CANVAS syndrome. Therapeutic measures includes avoiding the supine and prone position when resting, vestibular rehabilitation, and pharmacologic treatment with aminopyridines, among others. In this article we present two cases of DBN and review of literature.

Effect of thyme essential oils (Thymus hyemalis and Thymus zygis) and monensin on in vitro ruminal degradation and volatile fatty acid production.

The effect of the essential oils of thyme on the in vitro ruminal degradability of a barley seed/alfalfa hay substrate was studied. Two essential oils were used, one from Thymus hyemalis (TH), rich in carvacrol, and the other from Thymus zygis (TZ), rich in thymol. Four experimental treatments of in vitro degradability, using the Daisy II(200/220) incubator, were conducted including a negative control (CO), a positive control at 7.5 microg/mL of monensin (MO), and two treatments with essential oils (TH or TZ) at 1.35 microL/mL. The material was incubated at 39.5 degrees C for various lengths of time. At each time, the disappearance of dry matter, crude protein, and neutral detergent fiber was measured. Volatile fatty acids (VFAs) were determined after 48 h of incubation. CO and MO provided (p < 0.01) higher values of potential degradability (a + b) of DM than the TH and TZ treatments (72.6 and 70.8 vs 53.2 and 48.2%, respectively). Also, crude protein degradability was lowest in the essential oil treatments. The CO treatment showed the highest potential degradability of NDF. The values of VFA production obtained (p < 0.001) with CO and MO treatments were higher than those obtained with TH and TZ treatments (21.0 and 19.1 vs 11.2 and 10.1 mM). The essential oils decreased the molar proportion of propionate, increasing the acetate/propionate ratio. In conclusion, the effects of essential oils at assayed doses would not be nutritionally beneficial to the ruminal energetic metabolism.

Enfermedad de Fahr y gestación / Fahr’s disease and pregnancy

Paciente nulípara de 46 años de edad diagnosticada de enfermedad de Fahr, que tras 2 años de tratamiento con L-DOPA, quedó gestante espontáneamente. El embarazo llegó a término, libre de síntomas, sin que precisara tratamiento. Tras el parto se pautó anticoncepción con progesterona. En la actualidad, tras 12 meses, continúa asintomática (AU)

We report the case of a 46-year-old nulliparous woman diagnosed with Fahr's disease, who became pregnant after 2 years of therapy with L-dopa. The pregnancy developed at term and the patient showed no symptoms of the disease, although she was not under treatment. After delivery, the patient was prescribed progesterone treatment and remains asymptomatic 12 months later (AU)

[Effect of etomidate and thiopental on the onset of rocuronium action]. / Efecto del etomidato y del tiopental sobre el comienzo de acción del rocuronio.

HYPOTHESIS: Differences in the hemodynamic effects of induction agents may cause them to affect the onset of action of rocuronium differently. OBJECTIVES: To compare the onset of action of rocuronium after induction with etomidate and thiopental. PATIENTS AND METHODS: Forty adult ASA I patients received 3 micrograms.kg-1. Three minutes later anesthesia was induced randomly with either 5 mg.kg-1 of thiopental (group I, n = 20) or 0.3 mg.kg-1 of etomidate (group II, n = 20). Rocuronium 0.6 mg.kg-1 was administered over 5 s. Baseline blood pressure and heart rate were measured just before delivery of rocuronium and just before intubation. Onset of action was defined as the time from injection of rocuronium until achievement of a blockade > or = 95% of the first electromyographic response in a trian-of-four stimulus of the short adductor of the thumb. We also studied intubation conditions. RESULTS: Etomidate was associated with a smaller decrease in systolic arterial pressure than was thiopental. Onset of action was 81 +/- 29 s in group I versus 72 +/- 23 s in group II (NS). Similar intubation conditions were observed in both groups. CONCLUSIONS: These results suggest that the induction drug does not affect rocuronium's onset of action.

Epidemiología de las heridas de tratamiento hospitalario en Colombia / Epidemiology of in hospital wounds and lessions in Colombia

Las heridas de tratamiento hospitalario son una entidad frecuente y aunque en Colombia no se conoce su epidemiologia, se sabe que no son un numero despreciable. El objetivo de este trabajo fue el de conocer la epidemiologia de las heridas en pacientes hospitalizados, en un periodo de 1 año, especificamente las heridas quirurgicas, por pie diabetico, ulceras por presion, ulceras varicosas y laparostomias. Además, quisimos investigar que especialidad las trata y quienes son los encargados de las cuidados básicos de estas. Enviamos un formato con su respectivo instructivo a hospitales de las diferentes regiones del pais, logrando la participacion de 11 de estos hospitales. Obtuvimos como resultados que de 185.405 egresos hospitalarios durante el año de 1995, 50.9 por ciento presentaba herida quirurgica; 0.17 por ciento, ulceras por presion; 0.14 por ciento, heridas por pie diabetico; 0.08 por ciento, ulceras varicosas; y 0.25 por ciento, laparostomias. De los pacientes con herida quirurgica, presentaron infeccion global 6.12 por ciento. En todas las heridas, el manejo básico era realizado por las enfermeras y en algunos casos tambien por auxiliares de enfermeria y/o medicos. El servicio de Cirugia General fue el encargado de tratar la herida quirurgica, las ulceras varicosas, las heridas por pie diabetico y las laparostomias, en la gran mayoria de los hospitales. Cirugia Plastica, Medicina Interna, Cirugia Vascular y Dermatologia fueron especialidades que, en orden de frecuencia, tambien trataron heridas en estos pacientes. Se plantea la necesidad de establecer un seguimiento y registro completo de las heridas en los hospitales como parte del tratamiento integral de estas.

Pharmacokinetics of ketorolac in children after abdominal surgery.

The pharmacokinetics of 2 doses of intravenous ketorolac (0.5 and 0.9 mg x kg-1) were studied in 14 children (age 2-8 years). A single dose of the drug was injected into the dorsum vein of one hand. Blood samples were collected at regular time intervals for 6 hours. Serum ketorolac concentrations were assayed using a high pressure liquid chromatography method. Pharmacokinetic values were estimated by a nonlinear computer program. The distribution volume (Vdarea), the total clearance (Cltotal), and elimination half-life (t1/2 beta) were similar in both groups of children who either received 0.5 or 0.9 mg x kg-1 of ketorolac. The estimated geometric mean Vdarea, Cltotal, and t1/2 beta ratios (95% CI in parentheses) for 0.9 mg x kg-1:0.5 mg x kg-1 were 1.24 (0.82, 1.50), 1.14 (0.88, 1.23), and 1.083 (0.40, 1.81), respectively. The pharmacokinetic parameters found in this study are different from those found by other authors in adult subjects.

Improving the cost-effectiveness of AIDS health care in San Juan, Puerto Rico.

In an era of decreasing availability of funds and increasing demand, the AIDS epidemic threatens to overwhelm health-care services in some countries. We describe a comprehensive model for the treatment of AIDS in San Juan, Puerto Rico, and compare it with traditional hospital-based services. Given the existing allocation of funds, the comprehensive model emphasised prevention, education, surveillance, early detection, and outpatient care to reduce hospital care. In 1987, the last year of the traditional system, there were 95 admissions of AIDS patients to hospital, and in 1988, the first year of the comprehensive model, there were 100 admissions. The mean length of stay of AIDS inpatients was reduced from 22.3 days in 1987 to 11.3 days in 1988, a 46.8% reduction (p = 0.001). The annual mean (SE) cost of inpatient care per AIDS patient fell from $15,118 (1699) in 1987 to $3869 (659) in 1988. Savings were used to improve non-hospital services, including outreach, education, emergency and outpatient care, laboratory and epidemiological services, and research, and to introduce an employee incentive scheme. Management strategies that reduce the length of inpatient care and provide less costly treatment alternatives can improve AIDS health care in developing nations.

[Fiber colonoscopy in children under 18. Our experience with 112 patients studied in the digestive endoscopy section of a general hospital]. / Fibrocolonoscopia en menores de dieciocho años. Experiencia en 112 pacientes estudiados por una sección de endoscopia digestiva en un hospital general.

The aim of the study was to evaluate the indications of colonoscopy, diagnostic accuracy and efficacy treatment of procedure in young patients aged less than eighteen years using standard forward colonoscopes Olympus CF LB2, CF LBw and CF HL20. Among 5,400 procedures done along eleven years, 112 (2.07 per 100) were performed in patients aged less than eighteen years, 37.6 per 100 of which were performed in children under ten years. In this group general anaesthesia was employed without complications. The most frequent indication of colonoscopy in young patients was rectal bleeding (62.5 per 100). Related to the frequency, in this series, the control of graft versus host disease in patients submitted to bone marrow transplantation was the second indication (11 per 100), followed by the study of chronic anaemia (4.2 per 100) and control of the chronic inflammatory bowel disease (4.2 per 100). Diagnostic accuracy reached 93.75 per 100. In 6 per 100 of the cases the exploration were considered unsatisfactory because inadequate cleaning of the colon. The most frequent diagnostic was "normal colon" (29.6 per 100 of the cases). Polyp was found in 21.2 per 100 of the cases. Polypectomy was performed in all indicated cases. One patient with multiple polyposis were submitted to surgery. Colonoscopy reached the right colon in 25.4 per 100 of the cases. In 54 per 100 of the procedures reached splenic angle and in 83.8 per 100 of the cases, all sigmoid colon was explored. From this experience we suggests that colonoscopy, using standard endoscopes, is a very useful diagnostic and therapeutic technique in child and in young people.(ABSTRACT TRUNCATED AT 250 WORDS)

Gangrena de Fournier / Fournier's gangrene

Se presenta un caso de Gangrena de Fournier en un varón de 69 años con necrosis de las cubiertas testiculares y peneanas con antecedentes de gota y diabetes mellitus. La búsqueda cuidadosa de bacterias no permitió identificar gérmenes producores de la gangrena. El estudio histopatológico demostró lesiones de trombosis capilar y arteriolar en vías de recanalización, por émbolos provenientes de la circulación general o trombosis formada in situ, por vasculopatía diabética. Probablemente sea ésta la causa más valedera de la gangrena de Fournier

Gangrena de Fournier / Fourniers gangrene

Se presenta un caso de Gangrena de Fournier en un varón de 69 años con necrosis de las cubiertas testiculares y peneanas con antecedentes de gota y diabetes mellitus. La búsqueda cuidadosa de bacterias no permitió identificar gérmenes producores de la gangrena. El estudio histopatológico demostró lesiones de trombosis capilar y arteriolar en vías de recanalización, por émbolos provenientes de la circulación general o trombosis formada in situ, por vasculopatía diabética. Probablemente sea ésta la causa más valedera de la gangrena de Fournier (AU)