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PubMed2002

[Intraepithelial capillary hemangioma?].

INTRODUCTION: Histological examination of a biopsy of a lesion of the glans penis revealed blood capillaries within the malpighian epithelium. CASE REPORT: A 66 year-old man exhibited two circumscribed red plaques of the glans penis following posthectomy. Their histological examination revealed blood capillaries within the epithelium without basal membrane and pericytes between the endothelial cells and keratinocytes. Further evolution was towards lichen planus of the genital mucous membranes. In spite of a verrucous carcinoma which had been surgically removed, the evolution within a follow-up time of 6 years was favorable. DISCUSSION: Blood capillaries ascending in the epithelium of the genital mucous membranes have been observed in a special variant of Zoon's balanitis, the lichenoid, telangiectatic and purpuric balanitis described by Jonquières in 1971. In our patient exhibiting a lichen planus of the glans penis, the occurrence of blood vessels in the malpighian layer of the epithelium may be interpreted as the consequence of an unusual epithelial and vascular regeneration of an erosive lichenoid lesion. It may also be interpreted as an original neoplasia, and could therefore be considered as a genital intraepithelial capillary hemangioma.

Aged↗
PubMed1996

Rapid detection of bovine herpesvirus 1 in the semen of infected bulls by a nested polymerase chain reaction assay.

A nested polymerase chain reaction (PCR) assay was developed for the detection of bovine herpesvirus 1 (BHV-1) in bovine semen and compared with the virus isolation method. When extended semen, commonly used in the bovine artificial insemination industry, was inoculated with BHV-1, the PCR assay detected BHV-1 DNA in semen inoculated at 0.25-2.5 TCID50 per 0.5 mL. In contrast, the lower limit of detection for virus isolation was 250 TCID50 of BHV-1 inoculated in 0.5 mL of extended semen. These methods were also used to detect BHV-1 in the semen of four bulls which were experimentally infected with BHV-1. All infected bulls demonstrated balanitis at 3 d post-inoculation (DPI) and severe balanoposthitis at 4 DPI. BHV-1 was detected in raw semen by virus isolation and PCR at 2 DPI, before balanitis was evident. For virus isolation, the last day that BHV-1 was detected during primary infection was 7 DPI for two bulls and 9 and 11 DPI for the other two bulls. In contrast, PCR detected BHV-1 in the bulls' semen until 14 or 18 DPI. For individual animals, PCR detected BHV-1 during primary infection for at least 1-10 d longer than virus isolation. Reactivation of BHV-1 from latency without the presence of visible lesions was promoted twice by two series of 5 d dexamethasone injections. For the first series of dexamethasone treatments, a positive virus isolation result was obtained on the 5th d of treatment for only one bull. In contrast, two bulls demonstrated evidence of viral reactivation on this day by PCR. All bulls shed BHV-1 in semen on d 4 after dexamethasone treatment, as evidenced by positive virus isolation and PCR results. One bull was still PCR positive 13 d later. For the second series of dexamethasone treatments, a small amount of virus was isolated from semen collected on d 3 or 4 after treatment for two bulls but not from the other two bulls. In contrast, semen samples from all bulls were PCR positive for either or both of these 2 d. In total, from 80 semen samples, 45 were PCR positive and 26 were virus isolation positive. Thus, the PCR assay detected BHV-1 shedding in bulls earlier, more often, and for a longer duration, than did the virus isolation method.

Animals↗
PubMed1986

The frequency of foreskin problems in uncircumcised children.

We performed a retrospective survey to determine the frequency of problems of the foreskin among uncircumcised children. Among 545 boys aged 4 months to 12 years, there were 272 uncircumcised boys and 273 control patients who were circumcised at birth. The total frequency of complications was significantly higher in the uncircumcised group (14% vs 6%). Both balanitis (6% vs 3%) and irritation (4% vs 1%) were more frequent among the uncircumcised children, but the difference was not statistically significant. Problems with adhesions were uncommon (1.5%) and equal in both groups. Symptomatic phimosis was seen in eight patients. The frequency of medical visits for penile problems was significantly higher in the uncircumcised group (10% vs 5%). Although the overall frequency of complications was higher among the uncircumcised children, most of the problems were minor.

Balanitis↗
PubMed1993

Polioviruses with natural recombinant genomes isolated from vaccine-associated paralytic poliomyelitis.

To determine how oral poliovirus vaccine (Sabin) strains evolve during replication in humans and to confirm the etiology of vaccine-associated paralytic poliomyelitis (VAPP), we examined 70 vaccine-derived strains isolated from VAPP cases. Two distant sequences of the poliovirus genome were targeted for a double restriction fragment length polymorphism assay (RFLP) of reverse-transcribed genomic segments amplified by PCR, an extension of the method that we described previously (Balanant et al., 1991). One (RFLP-1) was a 480-long nucleotide sequence coding for the N-terminal part of the VP1 capsid polypeptide, situated in the 5' third of the viral genome (nucleotides 2401-2880). The other (RFLP-3D1) was a 291-long nucleotide sequence coding for a part of the viral polymerase, situated near the 3' end of the genome (nucleotides 6086-6376). Strain-specific restriction profiles could be generated for different field isolates by using three restriction enzymes in each case: HaeIII, DdeI, and HpaII for RFLP-1 and HaeIII, DdeI and RsaI for RFLP-3D1. With few exceptions, the vaccine-specific RFLP profiles were found to be conserved in both regions during replication of these viruses in humans. Thus, RFLP could be used as a marker so as to identify the origin of viral isolates at both ends of their genome. Whether viral isolates were vaccine-derived was determined by using strain-specific monoclonal antibodies and RFLP-1. Among the 70 isolates, 21 of the 43 type 2 strains and 15 of the 22 type 3 strains had a recombinant genome. None of the 5 type 1 Sabin-derived isolates was found to be recombinant. Both intertypic vaccine/vaccine and vaccine/non-vaccine recombinants were detected. Partial nucleotide sequencing confirmed the RFLP results in all cases that were investigated. In one case, it was possible to predict the recombination junction site from the restriction profiles. This site was more precisely localized by sequencing. The C6203 > U nucleotide substitution, which is suspected to contribute to the reversion toward neurovirulence of the attenuated Sabin 1 strain, was detected in almost all the recombinant genomes containing Sabin 1-specific sequences at the 3' extremity. This mutation was detected by identification of the modified RsaI profile in the RFLP-3D1. The results presented in this paper suggest that recombination, alone or together with mutation, might be one of the mechanisms of the reversion toward neurovirulence of attenuated vaccine strains and of the natural evolution of poliovirus.

Base Sequence↗
PubMed1999

Three cases of serious infection caused by Aerococcus urinae.

Three cases of serious infection caused by Aerococcus urinae are presented: a patient with endocarditis and two patients with soft-tissue infection (phlegmon and balanitis respectively). The literature on Aerococcus urinae infections is reviewed and the antibiotic therapy discussed. Aerococcus urinae is a pathogen isolated primarily from urine specimens of elderly patients with local or systemic predisposing conditions. Most infections are mild, but serious infections such as endocarditis and septicemia/urosepsis have been described. Penicillin or ampicillin in combination with an aminoglycoside and close monitoring of the patient's clinical status and laboratory results would seem to be the best strategy for management of cases of serious infection.

Aged↗
PubMed1984

Meatoplasty for gross urethral stenosis: a technique of repair and a review of 32 cases.

This paper is a review of the treatment of 32 cases of meatal stenosis arising as a complication of recurrent balanoposthitis (26 cases) or balanitis xerotica obliterans (six cases). There was gross scarring of the glans and the terminal urethra resulting in a contracted glans and a pinhole meatus. These deformities were treated successfully by segmental excision of all the scar on the glans and resurfacing the raw area with a local preputial or penile skin flap. In two patients a ventral midline flap was introduced as an island flap. In no case was a ventral slit made as the only definitive treatment of the meatal stenosis. Two instruments were made specifically to facilitate this type of operation.

Balanitis↗
PubMed1984

Papulosquamous lesions of glans penis.

The presentation of a scaly papule or plaque on the glans penis should suggest more wide-spread papulosquamous disease. Careful examination of the remaining body surface, including the oral mucosa and nails, in almost all cases will yield clues to the correct diagnosis. Papulosquamous disease which may present as a penile lesion include psoriasis, Reiter syndrome, lichen planus, lichen nitidus, seborrheic dermatitis, secondary syphilis, fixed drug eruption, erythroplasia of Queyrat, plasma cell balanitis of Zoon, bowenoid papulosis, and discoid and lichenoid chronic dermatosis of Sulzberger and Garbe.

Adult↗
PubMed2002

Common skin disorders of the penis.

Diseases of the male genitalia range from infectious lesions to inflammatory and neoplastic conditions, including many genital manifestations of more general skin diseases. This review highlights the clinical features, diagnosis and treatment of the most common dermatoses of the male genitalia. Herpes genitalis and infections caused by human papillomavirus (HPV) are increasing, particularly in young sexually active people. Herpes simplex virus infection is the commonest infectious cause of genital ulceration, with evidence that many infections are asymptomatic. HPV infection may be latent, subclinical and clinical. The most common causal agents for condyloma acuminatum are low-risk HPV 6 and 11; high-risk HPV types 16 and 18 are associated with premalignant and malignant lesions. Treatment for genital warts remains unsatisfactory; recurrences are common. Imiquimod, a new topical immunotherapeutic agent, which induces interferon and other cytokines, has the potential to be a first-line therapy for genital warts. Scabies and pediculosis are transmitted by skin-to-skin contact and sexual transmission is common, with the penis and scrotum favourite locations for scabious lesions. Oral ivermectin, a highly active antiparasitic drug, is likely to be the treatment of choice, but until approval is granted it should be reserved for special forms of scabies. Common skin diseases, e.g. psoriasis and lichen planus, may have an atypical appearance in the genital area. The typical psoriatic scale is usually not apparent because of moisture and maceration. Allergic contact dermatitis of the genital area may result from condoms, lubricants, feminine hygiene deodorant spray and spermicides. More often, contact dermatitis is irritant, resulting from persistent moisture and maceration. Lichen sclerosus is a chronic inflammatory disease that occurs as atrophic white patches on the glans penis and foreskin. The penile form is a common cause of phimosis in uncircumcised men; involvement of the urethral meatus may lead to progressive meatal stenosis. Plasma cell balanitis is a benign, idiopathic condition presenting as a solitary, smooth, shiny, red-orange plaque of the glans and prepuce of a middle-aged to older man. Squamous cell carcinoma (SCC) in situ, e.g. erythroplasia of Queyrat and Bowen's disease, cannot be excluded clinically; their apparent clinical benignity may lead to lengthy periods of misdiagnosis and biopsy is required to confirm the diagnosis. SCC is the most common malignancy of the penis and the role of oncogenic HPV-types has been also established in SCC of the penis. Prevention of SCC of the penis presupposes an identification of risk factors, early detection of all pre-cancerous lesions and treatment of phimosis.

Balanitis↗
PubMed1992

"Triple incision plasty". A convenient procedure for preputial relief.

Circumcision is the accepted operation to treat phimosis. However, when the purpose is to achieve retractility of a narrow foreskin to avoid further scarring and phimotic development after recurrent balanitis, a preputial plasty might be sufficient. Several methods with single or multiple incisions have been introduced throughout the years. None of them seems to have gained general acceptance. Single plasties tend to give cosmetically unsatisfactory results with an apparent cleft or deformity, while the multiple ones, where the deformity is more or less spread around the circumference, are not always easily done, at least not in children. Still, circumcision seems to remain the standard procedure for preputial relief. A simple technique, where three longitudinal incisions are transversely sutured, is described. It has been used in a series of 63 consecutive patients with good results, and seems to offer a good compromise between simplicity and cosmetical demands.

Adolescent↗
PubMed2006

Syphilis mimicking Reiter's syndrome in an HIV-positive patient.

A 38-year-old man with HIV infection presented with panuveitis, urethritis, and a papulosquamous eruption on his palms and soles. Careful physical and laboratory examination led to the diagnosis of syphilitic keratoderma, uveitis, and balanitis. The patient was successfully treated with penicillin and prednisone therapy. Because the initial presentation was difficult to distinguish from the symptoms of Reiter's syndrome, a high degree of clinical suspicion was required to accurately diagnose syphilis, a curable and potentially fatal disease.

Adult↗
PubMed1980

Phimosis in boys.

Phimosis, defined as scarring of the tip of the prepuce, was studied prospectively in a series of 23 boys aged 4 to 11 years. There was little to support the contention that the condition is caused by trauma, or by ammoniacal or bacterial inflammation of the prepuce, nor could any other aetiological factor be identified. Histological examination of the foreskin showed the appearances of Balanitis Xerotica Obliterans in 20 of 21 specimens submitted for study.

Balanitis↗
PubMed1986

Plasma cell balinitis of Zoon.

Superficial lesions of the glans penis can pose diagnostic difficulties. Plasma cell balanitis is such a condition and it may be confused clinically with erythroplasia of Queyrat. It is unresponsive to topical medication and curable only by circumcision.

Aged↗
PubMed2004

Home-dilatation of the urethral meatus in boys.

OBJECTIVES: To evaluate the efficacy of dilatation of the stenotic urethral meatus in boys at home. PATIENTS AND METHODS: Eighteen boys aged 3-15 years, or their parents, were taught to dilate the urethral meatus at home. The cause of the stricture was balanitis xerotica obliterans (BXO) in five and consequent upon hypospadias surgery in 12, of whom two were complicated by BXO, and one after circumcision for cultural reasons. One boy was re-referred after an interval of 3 years because of apparent deterioration of the stream of urine. Meatal dilatation was taught in the home by one of the authors (J.M.S.). RESULTS: Nine patients were cured by the first course of dilatation, four relapsed early after initial success but responded to further treatment, and three proceeded to meatoplasty because they had no response. Two relapsed late and one responded to further dilatation but the other required surgery. CONCLUSION: Dilatation of the urethral meatus can be taught successfully to boys or their families at home, thus avoiding repeated hospital attendance and often general anaesthesia.

Adolescent↗
PubMed1980

Lichen sclerosus et atrophicus, multiple dysplastic keratoses, and squamous-cell carcinoma of the glans penis.

A man who had been circumcised in adulthood developed, in sequence, balanitis xerotica obliterans (lichen sclerosus et atrophicus), multiple dysplastic keratoses, and a superficial, well-differentiated squamous-cell carcinoma on the glans penis. Squamous-cell carcinoma that develops after circumcision in adulthood tends to be more aggressive in biologic behavior and more malignant-looking in histology. Cancer developing within lesions of lichen sclerosus et atrophicus has been reported rarely.

Balanitis↗
PubMed1980

Cancers, precancers, and pseudocancers on the male genitalia. A review of clinical appearances, histopathology, and management.

Leukoplakia penis and balanitis xerotica obliterans are precancerous lesions. Bowen's disease, erythroplasia (Queyrat), and extramammary Paget's disease are carcinomas in situ. Lesions of both types may closely mimic benign skin conditions that may occur in the genital region. Histologic examination is usually the only certain means of diagnosis. The same considerations apply to pseudomalignancies, e.g., giant condyloma acuminatum (Buschke-Loewenstein), which clinically behaves as a carcinoma but histologically appears benign, and Bowenoid papulosis, a new entity that is believed to be benign although it has histologic features of a carcinoma in situ.

Balanitis↗
PubMed1994

Perianal streptococcal dermatitis associated with guttate psoriasis and/or balanoposthitis: a study of five cases.

Perianal streptococcal dermatitis (PSD) is a recently described cutaneous entity caused by group A beta-hemolytic streptococci. It is characterized by perianal erythema, sometimes associated with functional disturbances. We describe four children (2 boys, 2 girls) who had acute guttate psoriasis and also PSD. One of these patients also had balanoposthitis. A fifth patient experienced an association of PSD and balanoposthitis without psoriasis. To our knowledge, the association between guttate psoriasis and PSD has only been reported in five children, and the one with balanitis has not been previously reported.

Anal Canal↗