Colonización bacteriana de las prótesis de pene tras su retirada por fallo mecánico / Bacterial colonization of penile prosthesis after its withdrawal due to mechanical failure

Introducción: La cirugía protésica para el tratamiento de la disfunción eréctil tiene un riesgo de infección de hasta un 3%, pero este riesgo puede aumentar hasta un 18% cuando se trata de una cirugía de recambio. Este aumento del riesgo de infección se atribuye a la colonización bacteriana de las prótesis durante la primera cirugía. Objetivo: Analizar la presencia de gérmenes en las prótesis que se retiran por fallo mecánico (no infección), así como los resultados quirúrgicos y su evolución. Materiales y método: Estudio retrospectivo de todos los recambios realizados entre el año 2013 y el 2016 en un solo centro. Se analizan datos demográficos, tipo de prótesis previa, procedimiento quirúrgico, estudio microbiológico y evolución. Resultados: De 12 procedimientos de recambio se realizó un estudio microbiológico de la prótesis extraída en un total de 10 casos. De los 10 recambios, los cultivos resultaron positivos en 5 casos (50%). Staphylococcus epidermidis fue el germen mayoritario. Todos los pacientes se sometieron a un procedimiento de lavado y se implantó una prótesis recubierta de antibiótico. No registramos infecciones del nuevo dispositivo implantado tras un seguimiento medio de 27,33 meses (DE 4,13; IC 95% 18,22-36,43). Conclusión: En nuestra población a estudio objetivamos un alto índice de colonización bacteriana de las prótesis que se recambian por fallo mecánico. Tras realizar un procedimiento de lavado en el momento del recambio no objetivamos un mayor número de infecciones que lo descrito en casos vírgenes

Introduction: Prosthetic surgery to treat erectile dysfunction has a risk of infection of up to 3%, but this risk can increase to 18% when the surgery involves replacement. This increased risk of infection is attributed to the bacterial colonization of the prosthesis during the initial surgery. Objective: To analyse the presence of germs in the prosthesis that is withdrawn due to mechanical failure (not infection), as well as the surgical results and its progression. Materials and method: A retrospective study was conducted of all replacements performed between 2013 and 2016 at a single centre. We analysed demographic data, prior type of prosthesis, surgical procedure, microbiological study and follow-up. Results: Of the 12 replacement procedures, a microbiological study of the extracted prosthesis was performed in a total of 10 cases. Of the 10 replacements, the cultures were positive in 5 cases (50%). Staphylococcus epidermidis was the most prevalent germ. All patients underwent a flushing procedure, and an antibiotic-coated prosthesis was implanted. We recorded no infections with the new implanted device after a mean follow-up of 27.33 months (SD 4.13; 95% CI 18.22-36.43). Conclusion: In our study population, we observed a high rate of bacterial colonization of the prostheses that were replaced due to mechanical failure. When a flushing procedure was performed during the replacement surgery, there were no more infections than those reported in treatment-naive cases

Bacterial colonization of penile prosthesis after its withdrawal due to mechanical failure. / Colonización bacteriana de las prótesis de pene tras su retirada por fallo mecánico.

INTRODUCTION: Prosthetic surgery to treat erectile dysfunction has a risk of infection of up to 3%, but this risk can increase to 18% when the surgery involves replacement. This increased risk of infection is attributed to the bacterial colonization of the prosthesis during the initial surgery. OBJECTIVE: To analyse the presence of germs in the prosthesis that is withdrawn due to mechanical failure (not infection), as well as the surgical results and its progression. MATERIALS AND METHOD: A retrospective study was conducted of all replacements performed between 2013 and 2016 at a single centre. We analysed demographic data, prior type of prosthesis, surgical procedure, microbiological study and follow-up. RESULTS: Of the 12 replacement procedures, a microbiological study of the extracted prosthesis was performed in a total of 10 cases. Of the 10 replacements, the cultures were positive in 5 cases (50%). Staphylococcus epidermidis was the most prevalent germ. All patients underwent a flushing procedure, and an antibiotic-coated prosthesis was implanted. We recorded no infections with the new implanted device after a mean follow-up of 27.33 months (SD 4.13; 95% CI 18.22-36.43). CONCLUSION: In our study population, we observed a high rate of bacterial colonization of the prostheses that were replaced due to mechanical failure. When a flushing procedure was performed during the replacement surgery, there were no more infections than those reported in treatment-naive cases.

Linfedema escrotal gigante / Giant scrotal lymphedema

La elefantiasis escrotal es una condición que ha sido historicamente descrita en áreas endémicas de filariasis, siendo menos frecuente su presentación idiopática o asociada a otras entidades. Presentamos un caso de elefantiasis escrotal gigante de causa adquirida al que se le practicó exéresis de estructura linfadematosa con reconstrucción con colgajo local y autoinjerto cutáneo. El caso clínico presentado es raro, ya sea por la baja frecuencia o por su etiología, así como por la importante magnitud del problema. Por esta razón hemos decidido presentarlo para dar a conocer posibilidades terapéuticas y realizar una revisión del tema (AU)

Scrotal lymphedema (scrotal elephantiasis) is a condition that has historically been described in areas endemic to filariasis. We present a case of giant scrotal elephantiasis. The patient was treated with scrotal reconstruction with local flap and skin graft. We present a rare case report, because of its low frequency or its ethnology so as the big magnitude of the problem. That´s why we decided to present this case in order to show therapeutical possibilities and to do a bibliographic review about the theme (AU)

Déficit de testosterona como factor de riesgo de fractura de cadera en hombres de edad avanzada / Testosterone-Deficiency as a Risk Factor for Hip Fracture in Eldery Men

Objetivos: La pérdida progresiva de la densidad mineral ósea debilita los huesos y aumenta la probabilidad de fracturas osteoporóticas. Es conocida la acción de los andrógenos en el mantenimiento de la densidad mineral ósea. Este hecho nos hace pensar que podría existir una relación entre los niveles de esteroides sexuales y la fracturas osteoporóticas de cadera. Material y métodos: Se realiza un estudio caso-control, donde los casos correspondieron a 54 varones con fractura de cadera, cuyos datos fueron apareados por edad con 54 controles varones. A todos los pacientes se les determinó niveles de testosterona total, globulina transportadora de hormonas sexuales, albúmina y estradiol para el cálculo de la testosterona libre y la testosterona biodisponible. Resultados: Los pacientes con fractura de cadera presentaron unos niveles de testosterona inferiores a los controles (8,74 n/mol/l frente a 11,16 nmol/l; p=0,116) al igual que de testosterona libre (155,1pmol/l frente a 204,4pmol/l; p=0,02). Los niveles de testosterona biodisponible fueron inferiores en pacientes con fractura de cadera (2,69nmol/l frente a 3,89nmol/l; p=0,002), siendo esta última el mejor predictor para fractura (OR: 1,58). Conclusiones: Los pacientes con fractura de cadera presentan unos niveles significativamente inferiores de testosterona libre calculada y biodisponible en nuestra población a estudio. Estos hallazgos sugieren que los niveles de testosterona libre y biodisponible son predictores independientes de fractura de cadera osteoporótica en pacientes de edad avanzada (AU)

Objetives: Progressive loss of bone mineral density weakens the bones and increases the probability of osteoporotic fractures. It is well known that sex steroids play a role in the maintenance of bone density. This fact makes us think there might be a correlation between sex steroid levels and osteoporotic hip fractures. Material and methods: A case-control study was performed. The cases were 54 men who suffered from hip fracture. They were compared with 54 age-matched male control subjects. Levels of total testosterone, sex hormone binding globuline, albumin and oestradiol were measured in all subjects in order to calculate free testosterone and bio-testosterone levels. Results: Men who suffered from hip fracture had lower serum total testosterone (8.74 nmol/L versus 11.16 nmol/L; p=0.116) and lower free testostenone (155.1pmol/L versus 204.4pmol/L; p=0.02) than control subjects. Bio-testosterone levels were lower in patients with hip fracture (2.69 nmol/L versus 3.89 nmol/L; p=0.002), being the latter the best fracture predictor (OR: 1.58). Conclusions: In our study population, men with hip fractures had significantly lower levels of calculated free testosterone and bio-testosterone. These findings suggest that free testosterone and bio-testosterone levels are independent predictors for osteoporotic hip fracture in eldery men (AU)

[Testosterone-deficiency as a risk factor for hip fracture in eldery men]. / Déficit de testosterona como factor de riesgo de fractura de cadera en hombres de edad avanzada.

OBJECTIVES: Progressive loss of bone mineral density weakens the bones and increases the probability of osteoporotic fractures. It is well known that sex steroids play a role in the maintenance of bone density. This fact makes us think there might be a correlation between sex steroid levels and osteoporotic hip fractures. MATERIAL AND METHODS: A case-control study was performed. The cases were 54 men who suffered from hip fracture. They were compared with 54 age-matched male control subjects. Levels of total testosterone, sex hormone binding globuline, albumin and oestradiol were measured in all subjects in order to calculate free testosterone and bio-testosterone levels. RESULTS: Men who suffered from hip fracture had lower serum total testosterone (8.74 nmol/L versus 11.16 nmol/L; p=0.116) and lower free testostenone (155.1pmol/L versus 204.4pmol/L; p=0.02) than control subjects. Bio-testosterone levels were lower in patients with hip fracture (2.69 nmol/L versus 3.89 nmol/L; p=0.002), being the latter the best fracture predictor (OR: 1.58). CONCLUSIONS: In our study population, men with hip fractures had significantly lower levels of calculated free testosterone and bio-testosterone. These findings suggest that free testosterone and bio-testosterone levels are independent predictors for osteoporotic hip fracture in eldery men.

Tratamiento con hidroxicobalamina para la intoxicación por cianuro: una causa rara de pseudohematuria / Treatment with hydroxocobalamin for cyanide poisoning: a rare cause of pseudohematuria

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