A case of late-stage lymphogranuloma venereum in a woman in Europe.

Lymphogranuloma venereum is caused by Chlamydia trachomatis serovars L1-L3. The third stage of the disease leads to chronic progressive lymphangitis. The first European case of elephantiasic enlargement of the female genitalia caused by C. trachomatis L2 serovar in decades is reported.

Carcinoma epidermoide de uretra y glande ¿dos tumores independientes? / Epidermoid carcinoma of the urethra and glans penis two independent tumors?

Un varón de 64 años fue tratado en nuestro hospital por presentar una gran tumoración en el glande peneano. Durante el acto quirúrgico se detectó otra neoformación en la uretra. El estudio microscópico mostró un carcinoma epidermoide concomitante en glande peneano y uretra sin tejido afectado entre ambos tumores

A 64 years-old man is treated in our hospital presenting a big tumor in glans penis. During the surgical act, another neoplasm is detected in the urethra. The microscopic study showed a concomintant epidermoid carcinoma of glans penis and urethra with non-affected tissue between both tumors

Lymphogranuloma venereum as a cause of rectal strictures.

Rectal strictures are uncommon in young patients without a history of malignancy, inflammatory bowel disease or previous surgery. Lymphogranuloma venereum of the rectum has been described as a rare cause of rectal strictures in the western world, mainly in homosexual men and in blacks. It presents with nonspecific symptoms, rectal ulcer, proctitis, anal fissures, abscesses and rectal strictures. Clinical and endoscopic findings as well as histology resemble Crohn's disease, which may be misdiagnosed. Serology is often positive for Chlamydia trachomatis but negative serology is not uncommon. We present two young black women who suffered from chronic diarrhoea, abdominal pain and weight loss. There was no previous history and investigations showed in both cases a long rectal stricture. Serology was positive in one patient. They were treated with erythromycin and azithromycin and they both underwent an anterior resection of the rectum. Postoperative histology confirmed the presence of lymphogranuloma venereum of the rectum. We conclude that rectal lymphogranuloma venereum is a rare cause of rectal strictures but surgeons should be aware of its existence and include it in the differential diagnosis of unexplained strictures in high-risk patients.

Incision and drainage versus aspiration of fluctuant buboes in the emergency department during an epidemic of chancroid.

GOAL OF THIS STUDY: To compare outcomes of incision and drainage with packing to needle aspiration of purulent buboes in patients with presumed chancroid. The safety and efficacy of incision and drainage were compared with that of needle aspiration. STUDY DESIGN AND METHODS: The study was a prospective randomized, nonblinded clinical trial carried out from April 1992, to January 1994 in an inner city emergency department. A consecutive sample of 27 adults with fluctuant inguinal buboes presumed or proven to be chancroid or lymphogranuloma venereum were eligible for inclusion. Patients were excluded if they were believed to have buboes secondary to disease other than chancroid. After informed consent was obtained, patients had buboes drained by needle aspiration or by incision and drainage with packing according to a random numbers table. RESULTS: Twenty-seven patients were included in the study (22 men and 5 women), with 12 randomized to incision and drainage and 15 to aspiration. The mean age was 35.7 +/- 13 years. Genital ulcer or bubo pus cultures for Haemophilus ducreyi were positive in seven patients, negative in 15 patients, and not done in five patients. Follow-up was obtained for 23 (85%) patients, 11 of whom had incision and drainage and 12 of whom had aspirations. No adverse effects were reported in either group. CONCLUSION: Incision and drainage is an effective method for treating fluctuant buboes and may be preferable to traditional needle aspiration considering the frequency of required re-aspirations in the study patients. Limitations of this study include lack of complete laboratory testing and lack of follow-up of all patients.

Estenosis rectal causada por enfermedad de Nicolas-Favre / Rectal stenosis caused by Nicolas-Durand-Favre disease

Se presentaron dos casos de pacientes con linfogranuloma venéreo, que causó estenosis rectal; fueron tratadas quirúrgicamente en el servicio de coloproctología del Hospital Docente "Comandante Manuel Fajardo", y un caso por idéntica enfermedad, del Hospital de reclusos. Se analizan las bases diagnósticas, formas clínicas y tratamiento quirúrgico de esta enfermedad(AU)

An operation for restoration of urinary continence following total loss of the urethra.

Twenty-three patients with urethral loss have been treated by the simple creation ofa "spout" from the bladder wall. The procedure is suggested for the surgical treatment of lymphopathia venereum and for consideration in certain other conditions when urinary diversion is unacceptable.

Rectal lymphogranuloma venereum in Jamaica

Lymphogranuloma venereum is a major public health problem in Jamaica. With improvement in the standard of living, better housing, better general education, a healthier sex education, and a more active programme of venereal disease control, the incidence of rectal lymphogranuloma should diminish. The early diagnosis and treatment of the proctocolitis by drugs is effective and should reduce the incidence of stricture. Major operations should be reserved for cases in which the more conservative methods of treatment are unlikely to succeed or have failed. At present, in Jamaica, operation necessitating a permanent colostomy should be considered more carefully than in this country. Unfortunately our attempts to eradicate the disease by operation and leave the patient with a functioning anus have been attended with only very limited success. Some of the failures may be attributed to insufficent experience with these operations, but involvement of the sphincter in the dense fibrotic process is probably responsible for the majority. In these fibrotic sphincters functional control is impossible. In a small number of cases intra-sphincter proctectomy in one stage by the method described by Dimitrui and Gregoresco (1933) has given promising results where the sphincter is free. The disease appears to be self-limiting. There has been no evidence of reactivation after removal of the affected gut even though this is rarely a complete en bloc excision or indeed even after colostomy only. Our follow up has been short. I have deliberately avoided the term "cure" because rarely has the compliment fixation reaction been reversed to negative. The significance of a persistently positive serological reaction in the absence of clinical evidence of disease is yet to be assessed. We have come a long way since John Hunter described the bubo 175 years ago and Frei placed the study of the disease on a firm aetiological basis 140 years later. In the past 35 years our knowledge of the lympho-granuloma venereum virus has increased, but the problem of treatment of rectal stricture, the most disabling complication of the disease, awaits solution. Morte (1933) stated: "The study of the stricture of the rectum is as fascinating as the treatment is discouraging. " In 1960 we can say: "Treatment of rectal stricture is often disappointing, but the results are encouraging" (Summary)

Rectal lymphogranuloma venereum in Jamaica

A brief history of lymphogranuloma with special reference to rectal involvement is given. Experience in Jamaica in the treatment of 144 cases of rectal lymphogranuloma is reported. In cases of proctocolitis, patients can be relieved of rectal stricture only by its removal but symptoms may be relieved by more conservative treatment. Excision operations should be reserved for the severe cases. The prognosis of proctectomy with preservation of sphincter function should be guarded. The abdomino-end-anal operation of Dimitriu and Gregoresco has given promising results. (Summary)

Rectal lymphogranuloma venereum in Jamaica

The clinical features of rectal lymphogranuloma venereum are described. The 91 cases of rectal lymphogranuloma have been studied at the University College Hospital of the West Indies since 1953. The pathogenisis of the disease is discussed and some doubts are expressed about the commonly accepted theory. The Complement Fixation Test appears to be no guide to the efficacy of treatment. The antibiotics are effective in producing a clinical cure of the disease in over 70 percent of cases, and have a beneficial effect even on the cases of established stricture. Radical surgery is used in cases of severe stricturing,"Esthiomene" or with recto-vaginal fistulae. Other forms of treatment have been used, being ineffective and occasionally dangerous