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In situ localization of interleukin-6 in normal skin and atrophic cutaneous disease.

Interleukin-6 (IL-6) is a multifunctional cytokine that participates in the inflammatory and immune responses. In human skin, keratinocytes produces IL-6, although the in vivo role of this cytokine is unknown. In the present study we investigated the in situ localization of IL-6 in normal epidermis (n = 10) and in a group of skin diseases characterized by epidermal atrophy. Formalin-fixed paraffin-embedded skin biopsies from patients with clinical and histopathological features consistent with localized scleroderma (n = 10), systemic scleroderma (n = 5), lichen sclerosus et atrophicus (n = 9) and balanitis xerotica obliterans (n = 7) were tested using polyclonal antibodies and avidin-biotin-peroxidase immunostaining. We demonstrated the presence of IL-6 in normal epidermis and in atrophic skin diseases. In normal skin there was moderate intercellular and intracellular reactivity detected using a high antibody concentration. In specimens with epidermal atrophy we detected intense cytoplasmic and intercellular immunostaining using a lower antibody concentration. The immunoreactivity was independent of the epidermal thickness. Plasma IL-6, measured by radioimmunoassay, was not elevated in plasma from patients with localized or systemic scleroderma. Increased IL-6 in the epidermis of selected skin diseases suggests that IL-6 may be related to the pathophysiology of dermatologic diseases characterized by epidermal atrophy.

Antibody Specificity↗

Prevalence of Ureaplasma urealyticum in the urethra of men without urethritis in relation to clinical diagnosis.

Ureaplasma urealyticum is one of the microorganisms possibly causing nongonococcal urethritis. In a prospective study, 606 men without urethritis presented to an STD clinic in a rural West German region were investigated for the prevalence of U. urealyticum in the urethra. The overall isolation rate of the organism was 21.3%. Analyzing patients grouped by clinical diagnoses, the isolation rate of U. urealyticum was significantly higher in the genital warts group (25%) and in the partner's control group (35%) than in the group of patients suffering from fertility disorder (15.2%) or balanitis (14%). These findings stress the importance and the difficulty to select the appropriate controls in clinical studies concerning the role of U. urealyticum in the male urethra.

Adult↗

CO2 laser for therapeutic circumcision in adults.

The use of carbon dioxide laser for 38 posthetomies or therapeutic circumcisions in the treatment of phimosis, paraphimosis, balanitis of Zoon or a genital infection by the human papillomaviurs permits clean and hemostatic incisions. The clean and dry wound produced by the carbon dioxide beam offers several advantages. It reduces the surgeon's risk of contamination by the HIV virus and the subsequent sear is regular and without edema. In 57% of primary phimosis cases, the histological analysis showed a lichen sclerosus et atrophicus.

Adult↗

Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons.

To assess the reasons for and outcomes of referrals concerning the foreskin, 100 consecutive patients seen in paediatric clinics were followed to discharge. 18 referrals were for circumcision on religious grounds. Of the other 82, the main reason for referral was non-retractability or phimosis. At clinic, 24 (29%) of these were deemed normal for age, 31 (38%) were treated with topical steroid (successfully in 25), 9 (11%) were listed for preputioplasty, 7 (9%) were listed for adhesiolysis, 7 (9%) were listed for circumcision, and 4 were listed for other forms of surgery. 6 patients were identified as having balanitis xerotica obliterans (BXO), a condition that had not been suggested on referral. With the advent of new treatments for foreskin disorders, circumcision is decreasingly necessary. Knowledge of the natural history of the foreskin, and the use of topical steroids, could shift the management of paediatric foreskin problems from the hospital outpatient department to primary care. BXO is not sufficiently recognized as a form of phimosis that requires operation.

Administration, Topical↗

Circumcision: a refined technique and 5 year review.

The vast majority of circumcisions currently performed in the UK are for phimosis or balanitis and the patients are not looking for the denuded glans appearance of a ritual circumcision. We present a refinement of the sleeve technique of circumcision, which involves Horton's test to define the proximal incision margin, and bipolar electro-dissection. A review of all patients undergoing circumcision at the Wordsley Plastic Surgery Unit, in a 5-year period, has shown this technique to be safe with a haematoma rate of only 1.4%, and an overall complication rate of 3%.

Anesthesia, Local↗

The pros and cons of routine circumcision.

The origin of the practice of circumcision is an ancient one having a ritual significance in most cases, but the operation is done primarily for hygienic purposes amongst English-speaking people. Critical evaluation of the indication for circumcision suggests that the hygienic principles are probably overrated. If it were understood that the anatomy of the prepuce and glans has a morphological development which in most cases removes the possibility of phimosis after the third year, less emphasis would be placed on the necessity for the operation. On the other hand, the feeling exists that boys who will require circumcision because of phimosis, balanitis, etc., should not be subjected to the operation at the age when psychological trauma can result. Convention and conformity demand the continuation of the procedure in many areas. The decision to circumcise remains a matter of individual preference as prescribed in the doctor-patient relationship.

Balanitis↗

The riddle of the sands: circumcision, history, and myth.

Although many nineteenth century misconceptions about the foreskin have been dispelled since Douglas Gairdner showed that infantile phimosis was not a congenital defect, other old ideas have proved more persistent. Among the most ubiquitous are the proposition that ritual or religious circumcision arose as a hygiene or sanitary measure; and the related idea that allied troops serving in the Middle East during the Second World War were subject to such severe epidemics of balanitis that mass circumcision was necessary. Both these claims are medical urban myths which should be firmly laid to rest.

Balanitis↗

[Urethral meatal stenosis in boys easily overlooked].

Three boys aged 8, 5, 3 and 9 years, respectively, appeared to have urethral meatal stenosis. In the first patient this appeared during a check-up following treatment for balanitis. Patient history revealed that his micturition duration was longer than before. In the second patient, who underwent surgical correction for hypospadia, it was discovered because he took longer to urinate than his brother. In the third patient stenosis was observed during an appointment for a retracted testicle; he had been circumcised earlier for cultural reasons. Meatomy was performed under anaesthesia in all 3 patients, after which the micturition duration and stream velocity were normal. The third patient continued to have an extremely large bladder capacity and residual volume. Meatal stenosis may lead to obstructive uropathy, urinary tract infection and eventually damage to renal parenchyma. Symptomatic presentation can be late. Diagnostic tests include urine analysis and culture, and uroflowmetry. Visual inspection by spreading the meatal dimple to visualise a pinhole urethra cannot be overemphasised.

Balanitis↗

[Mycoses and diabetes].

Generally, diabetic patients are more susceptible to skin infections. Although the overall incidence of skin mycoses in diabetics is not higher as compared with healthy population, diabetics seem to suffer from certain types of mycoses more frequently. They are not only tinea pedum and onychomycosis, but also candidoses (especially candidal balanitis). In older patients, sole tinea is often overlooked. Nevertheless, it impairs integrity of skin and lets in bacterial infections causing diabetic foot and aggravates nail infections. Onychomycosis in diabetics is far from being a cosmetic problem only. On the contrary, it is potentially a very dangerous disease. Hypertrophic and deformed nails damage adjacent skin and their pressure can result in decubital ulceration of neighbouring fingers or nail beds. This condition can even lead to finger gangrene. Therapy of onychomycosis in diabetics and seniors should be specific: the most effective therapeutic procedure proved to be the combination of systemic treatment with terbinafine and atraumatic chemical ablation with subsequent local treatment.

Balanitis↗

[Inflammatory changes in the urogenital tract and therapeutic possibilities in the course of adjuvant disease in the male rat].

The adjuvant disease of the rat is an experimental disease, not only important as an arthritis model, but also as an "urethritis model" in clinical and therapeutical respects. The polyarthritic syndrome in rats following injection of Freund's adjuvant also shows regularly involvement of the genitourinary system. Urethritis, cavernitis, and balanitis are common inflammatory manifestations of the penis, which can mostly be observed. In the peritesticular and periepididymal fat, granulomata and nonspecific inflammatory reactions do occur. Prostata, bladder, kidneys, testes, and epididymis are seldom involved in the inflammatory process. This therapeutical study demonstrated clearly that acetylsalicylic acid (dosage: 80 mg/kg BW/day) cannot be of benefit for these changes. However, it was possible to significantly influence the inflammatory changes by using prednisolone (dosage: 1.5 mg/kg BW/day).

Animals↗

Autodigestion of the glans penis and urethra by activated transplant pancreatic exocrine enzymes.

A case of synchronous kidney and pancreas transplantation in which a whole pancreas graft had been drained to the urinary bladder is discussed. On the 137th postoperative day, the patient presented with symptomatic balanitis and urethritis. Documented enzymatic activation of the trypsinogen/chymotrypsinogen, which is not present in symptom-free control patients, was thus thought to be responsible for these symptoms. Conversion to enteric drainage by means of a Roux-en-Y loop resulted in resolution of both symptoms and urinary enzymatic activation. Recurrent urinary tract infections were thought to be the most likely mechanism responsible for these findings.

Adult↗

Neonatal circumcision and penile problems: an 8-year longitudinal study.

The prevalence of penile problems was examined in a birth cohort of more than 500 New Zealand children studied from birth to 8 years of age. By 8 years, circumcised children had a rate of 11.1 problems per 100 children, and uncircumcised children had a rate of 18.8 per 100. The majority of these problems were for penile inflammation including balanitis, meatitis, and inflammation of the prepuce. However, the relationship between risks of penile problems and circumcision status varied with the child's age. During infancy, circumcised children had a significantly higher risk of problems than uncircumcised children, but after infancy the rate of penile problems was significantly higher among the uncircumcised. These associations were not changed when the results were adjusted statistically for the effects of a series of potentially confounding social and perinatal factors.

Balanitis↗

Treatment of localized scleroderma and lichen sclerosus with etretinate.

Eight patients with lichen sclerosus and 8 patients with localized scleroderma were treated with etretinate (Tigason) at doses of 0.5 mg/kg body weight for between 3 and 12 months: 2 of 3 patients with juvenile type lichen sclerosus cleared, whereas the lesions of 5 patients with balanitis xerotica obliterans, kraurosis vulvae and extragenital lichen sclerosus were unchanged or even progredient. 2 of the patients with localized scleroderma cleared with slight atrophy. The lesions of 5 others failed to resolve but progression was halted under continued therapy; after drug withdrawal, the lesions resumed progression in 2 patients. We conclude that only moderate therapeutic effects can be achieved with etretinate in both lichen sclerosus and localized scleroderma.

Adult↗

The significance of finding curved rods in the vaginal secretions of patients attending a genito-urinary medical clinic.

Curved rods were found in 108 (21.6%) of 500 women consecutively attending a genito-urinary medical clinic. A positive association was elicited with the wearing of an intra-uterine contraceptive device (p less than 0.001), intercourse with a casual or multiple sexual partners within the preceding 3 months (p less than 0.001) and concurrent chlamydial infection of the uterine cervix (p less than 0.025). There was no apparent relationship with contact with non-candidal balanitis, but an increased rate (31.3%) was noted in contacts of non-gonococcal urethritis indicating a need for further research into a possible aetiological role.

Bacteria, Anaerobic↗

Point of focus: poor genital hygiene and terminal urethral strictures.

Males attending the urology clinic with strictures of the terminal urethra were studied. Evident frank balanoposthitis, subpreputial calculi and infected urine in the preputial sac were seen in a sizable number, 35% of them were suffering from a second urethral stricture also, either in continuity over the whole length of the penile urethra or in the bulbomembranous area. Balanitis xerotica obliterans was responsible for those terminal urethral strictures in nearly 20%. All patients required terminal urethroplasty in addition to appropriate surgical procedures for other stigmata. Knowledge and sense of hygiene of the genitalia were lacking in most of the patients.

Adolescent↗

[Acquired phimosis due to lichen sclerosus et atrophicus].

From January 1986 to December 1991, 6 cases of acquired phimosis secondary to balanitis xerotica obliterans were observed. The authors report their experience in the diagnosis and treatment of this disease. Five patients were treated with plastic of the foreskin, one was circumcised and treated with local instillation of corticoids. The authors conclude that the histological study of the specimen is very important to demonstrate the nature of the lesion.

Adolescent↗

Tale of a 'dicky' heart.

Coronary heart disease can be a silent disease and does not always present with symptoms directly attributable to the heart. In this article, a presenting complaint of balanitis led to the diagnosis of diabetes mellitus, which led to the detection of hypertension and hypercholesterolaemia and eventually to the diagnosis of severe coronary heart disease.

Balanitis↗

[Necroses following the use of Pyoktanin].

In a patient suffering from chronic balanitis, necrotic lesions of the glans penis and the internal part of the prepuce occurred when treated with 1% gentian violet. Necrosis after treatment with gentian violet is a rarely seen complication which should be borne in mind.

Adult↗